Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.
If a couple was wanting to invite you into their bedroom for a more hands on approach, would that be something you would consider?
-Anonymous
What a fun ethics question to start the week. In counseling school, we spend a lot of time dissecting ethical dilemmas like this one and figuring out what would be the best decision for everyone involved. While some situations have more of a grey area, engaging in any form of sexual contact with your client usually is agreed to be universally unacceptable. Although, you wouldn’t think this by watching movies and tv (or TikTok). In doing research, it is really hard to find statistics on how many mental health professionals lose their license due to engaging in sexual activity with a client, but I can think of two off the top of my head. What sets sex therapists apart from traditional therapists is our focus on human sexuality. While we do “invite sex” into the therapeutic space, it’s always from a place of helping, never from a place of personal desire. Our role is to guide clients through the sludge of sex negativity. With that in mind, beyond the obvious reasons, I want to highlight two ethical tenets that stand out to me when it comes to never engaging in sexual contact with clients.
First, let’s talk about the ethical principle of non-maleficence, also known as “do no harm.” As a therapist, I need to remember that non-maleficence is not just a lofty principle but something that must guide every action I take with my clients. It means I have to continually ask myself: “Will this choice help or harm?” This applies not only to the interventions I use, the words I choose, or the way I structure sessions, but also to the boundaries I uphold in the therapeutic relationship. I tell my supervisees all the time that it is not the responsibility of the client to uphold the professional boundary that is created, but ours. As much as there are clients I might genuinely get along with and even imagine being friends with outside the therapy room, my role is not to be their friend, it’s to remain the objective, trusted professional they’ve chosen to help guide them.
Clients come to me in vulnerable states, often carrying immense trust that I will hold their experiences with care. Society judges us and our desires all the time, so I need to make sure the space I create for them is one of safety and openness. My responsibility is to honor that trust by maintaining clear, professional boundaries that keep them safe. This is precisely why sleeping with clients is never ethical in my opinion. It does not matter how much I may find my client attractive (and yes, mental health professionals are human, so of course we can notice attraction). But acting on that attraction would cause irreparable harm and ultimately violate the very principle of “do no harm” that lies at the core of my role as a clinician.
Another ethical tenant that I should speak to would be the one regarding dual relationships.
In therapy, dual relationships occur when a counselor and a client engage in a secondary relationship outside of their professional one. The main one clinicians have to avoid, that entertainment does a horrible job upholding, is moving from a therapist/client dynamic to friendship. Obviously, this would also include a sexual relationship with a client. According to Rule 4757-5-04 of the Ohio Administrative Code, therapists are forbidden to engage in any sexual behavior with a client and must wait at least five years before engaging with a previous client. As an added layer, the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), which is the national certification board for sex therapists, states that a clinician certified by them is never allowed to engage in a sexual relationship with a former client.
But all is not lost, Anonymous. While the work we would be doing would be primarily verbal, sex therapists may also collaborate with other professionals, such as sexological bodyworkers. A sexological bodyworker is a professional trained to guide clients in deepening their connection to their body, sexuality, and pleasure through hands-on, trauma-informed, and body-centered practices. While therapists and sexological bodyworkers hold different roles and scopes of practice, the two approaches can complement each other: therapy addresses the psychological and relational aspects, while bodywork offers a more experiential, embodied pathway to healing and sexual growth.
Sexological bodyworkers practice from a framework of unilateral touch, meaning the focus is solely on the client receiving, rather than a mutual exchange. Unlike bilateral touch, which implies a back-and-forth dynamic between two people, unilateral touch ensures that all attention is directed toward the client’s learning, healing, and embodied experience. This distinction is essential because sexological bodywork is not about having sex or engaging in mutual pleasure. Through guided practices, consent-based touch, and somatic exercises, bodyworkers help clients explore their sensations, understand their arousal patterns, and release shame or tension stored in the body. The intention is always to support the client in developing greater awareness and connection to their own body, not to meet the needs of the practitioner.
You haven’t heard of this because in the United States, it is considered sex work and, as you know, the United States is not a huge fan of sex work. This categorization has made sexological bodywork difficult to regulate and widely misunderstood, even though it is rooted in education, consent, and personal healing rather than in the exchange of sexual services. In many other countries, sexological bodywork is recognized as a legitimate therapeutic and educational practice, helping clients better understand their bodies and reduce shame around sexuality. Unfortunately, the stigma around sex work in the U.S. has led to confusion, with people often lumping sexological bodywork into the same category as transactional sex, rather than recognizing it as a professional practice.
When it is all said and done, there is a reason I chose to take the path of becoming a Licensed Professional Clinical Counselor and AASECT Certified Sex Therapist, and not a sexological bodyworker. I truly believe in the power of talk therapy and the impact it can have on transforming people’s lives. I also believe in the power of touch, but I’ve chosen to leave that path to those who are willing to take that risk. So, if anyone is looking for a professional to assist in the bedroom, a sex therapist would not be the best fit. Instead, do some research on sexoloigcal bodyworkers and if you need a referral, I would be happy to help.
Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.
Disclaimer: The advice provided in this column is intended for generalinformational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.
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