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Thu, 08/01/2024 - 01:57
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LET’S TALK ABOUT SEX:
AN ART THERAPY WORKSHOP
TO INCREASE THERAPEUTIC
ATTUNEMENT
PRESENTED BY: MOLLY HURD
APRIL 22, 2024
AREAS OF NOTE
All of the images used in this workshop are either pulled from queer affirming art history sites,
were showcased in museums for shows highlighting artists and subject matter relating to sex,
sexuality, or queerness, or are my own.
If any of these images interest you, I would encourage you to explore them further through the
resource list.
I primarily utilized existing institutions within the United States when referencing resources and
education opportunities for this presentation. This is because it is the information that was most
accessible and familiar. It’s important to note that this presentation is heavily westernized and norms
regarding art therapy and sex therapy are based on United States standards.
This presentation is not comprehensive and I encourage you to take note and further explore areas
that peak your curioisity.
PURPOSE
STATEMENT
Figure 1
The purpose of this research paper is to
develop a workshop curriculum to introduce
mental health clinicians to the relevance and
importance of integrating art therapy and sex
therapy while providing an introduction to
accessing further training and resources.
(N/A). German image of St. Wilgefortis (N/A)]. Queer Art History.
https://www.queerarthistory.com/category/transgender-gender-nonconforming/
JUSTIFICATION
ATCB
1.1.6 Art therapists must not engage in therapy
practices or procedures that are beyond their
scope of practice, experience, training, and
education.
1.2.4 Art therapists shall develop and improve
multicultural competence through ongoing
education and training. Art therapists shall use
practices in accordance with the client’s or group’s
age, gender, gender identity, gender expression,
sexual orientation, ethnicity, race, national origin,
culture, marital/partnership status, language
preference, socioeconomic status,
immigration/citizenship status, ability,
religion/spirituality, or any other identity factor.
Both fields are unique in structure and have the ability to
skirt around the often limiting structures of mental health
care. Western mental health care has historically been
weaponized against people who do not fit in a sexual norm
constructed by a patriarchal society (Pierik, 2022) . Due to
this, the use of art therapy with sex therapy can provide a
radical space for non-oppressive and comprehensive
mental health care.
TERMINOLOGY
Let’s get on the same page
Art Therapy- “Uses active art-making, the creative process, and
applied psychological theory—within a psychotherapeutic
relationship—to enrich the lives of individuals, families, and
communities” (AATA, para. 3).
Directive- An art prompt used in art therapy and for art as therapy.
Art Therapist- “Mental health clinicians with Master’s degrees or
higher that serve clients in different settings—from medical
institutions and schools, to wellness centers and independent
practices” (AATA, 2023, para. 4).
Sexuality- A person's identity in relation to the gender or genders to
which they are (or are not) typically attracted to.
Sex Therapy- “Any type of psychotherapy that addresses a
person’s sexual problems” (Caffrey, 2022).
Sex Therapist- Help clients understand their own sexual needs
concerning their mind and body and how to develop healthy sexual
practices and relationships. Although sex therapy has a significant
focus on sex, a sex therapists cover a much broader range of the
human experience than exclusively sex (AASECT, 2024).
Sex- Physical contact between individuals involving sexual
stimulation; sexual activity or behavior (OED, 2023).
Bias- Prejudice in favor of or against one thing, person, or group
compared with another, usually in a way considered to be unfair.
(OED, 2024)
LITERATURE REVIEW
Relationship between Art Therapy and Sex Therapy
Person Centered Theory
Relationship and client driven
Expressive Therapies Continuum (ETC)
Framework for AT
Attachment Theory
Identifies themes that encourage or discourage attachment at a young age (Hutchinson, 2023).
Emotionally Focused Therapy (EFT)
EFT has three stages: de-escalation, changing interaction patterns, and consolidation and integration
(Caffrey, 2023), and is structured based on Attachment Theory.
LITERATURE REVIEW
Multicultural and Social Justice Counseling Competency
(1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling
and advocacy interventions.
Weaponized Sexual Norms Throughout Society and Mental Health Care
Patriarchal Power (Pierik, 2022)
History of homosexuality in the DSM (Hectors, 2023)
Cultural Significance of Integrating Art Therapy and Sex Therapy
Integrating a sex-positive approach in Art Therapy (Kirby, 2023)
“Visual expressions rather than the role of the greater visual culture in shaping clients’
perspectives and creating internalized oppression” (Talwar, 2010)
LITERATURE REVIEW
Sexuality and Gender Explored Through Art Therapy
Somatic art therapy to explore and affirm LGBTQIA+ identity
Art therapy for coming out
Couples and Art Therapy
Metzl utilized EFT and expressive sex therapy as a framework while integrating art therapy with
couples
Art based directives in a Swedish counseling system for couples- couples art therapy through
government funding (Fjellfeldt & Rokka, 2022)
Use of poetry therapy in sex therapy (Floyd, 2021)
Available Sex Therapy Education for Art Therapists
2 separate human sexuality for art therapists elective courses (Metzl, 2013) and (Kirby, 2023)
Figure 2
WORKSHOP
STRUCTURE
First Half (85 minutes)
Relationship between Art Therapy and Sex Therapy
Terminology
Social Justice in Therapy
Historical Awareness
Understanding Bias
Ethics and Scope
10 minute break
Second Half (85 minutes)
Talking about sex and sexuality in sessions
Art Therapy directive for topics of sex/sexuality
Høeg, M. (1895-1903). [Photograph]. Queer Art History.
https://www.queerarthistory.com/category/transgendergender-non-conforming/
This is an interactive workshop and will include several art therapy
directives as well as digital engagement. Please be in a location
where you feel safe enough to fully engage and create.
WHO IS THIS WORKSHOP FOR?
Everyone! No matter the demographic you work with, sex and sexuality are human experiences that
shape the clients we work with and ourselves!
It’s important to note that the directives discussed in this workshop were
pulled from art therapists and should only be used by trained art therapists.
Many of these directives can be utilized as a form of art as therapy for clients
to process emotions, but non-art therapists should seek further training and
certifications to practice within their scope.
“Even art therapists who do not wish to operate as sex therapists or specialize in this
topic can and should consider the ways that the art interventions they already use
might support clients’ wellbeing while they more directly acknowledge their clients’
sexuality”
When Art Therapy Meets Sex Therapy
Einat Metzl, 2017
1 MINUTE DIRECTIVE
DRAW A SMILE FACE
Materials:
Notecard of sheet of paper
Any drawing material
Prompt:
Quickly draw a smile face on your sheet of paper.
PROCESSING
Hold up your smile face. Are any the exact
same? Any different? How may of you
associated the smile face with an emoji? A
symbol from your childhood? Or a cultural
norm?
Here are a few! This list is not comprehensive.
All responses are
anonymous
Scan the QR code
Figure 4
WHY SOCIAL JUSTICE
IS IMPORTANT FOR
ART AND SEX
THERAPY
The World Health Organization (WHO) defines sexual
health as “fundamental to the overall health and
wellbeing of individuals, couples, and families, and the
social and economic development of communities and
countries” (World Health Organization [WHO], n.d., para.1).
(N/A). Portrait of We’wha Holding a Clay Ceremonial Prayer-Meal
Basket (hand-colored)]. Queer Art History.
https://www.queerarthistory.com/category/transgender-gender-nonconforming/
SOCIAL JUSTICE: THE WHY AND HOW
Pierik defines Patriarchal Power as “men’s appropriated power over the flesh, over
biological processes but also the knowledge and appearances of these processes, which
results in it presenting itself as the ‘natural’ default state, and women’s challenge to it as
unnatural and against biology.” (Pierik, 2022).
Working from a social justice lens encourages broader perspective taking and cultural
competency.
Creating space to safely voice societal inequities can empower clients to recognize
external factors that impact them.
Working from a multicultural lens provides varied viewpoints and understanding of self
and society.
Both awareness and understanding are intended to be an ongoing responsibility to
challenge clinicians to recognize their own bias, educate themselves on the elements
of human sexuality (both physically and emotionally), and identify the social rules that
dictate sexual norms. Skills can be approached once a clinician’s self-awareness and
knowledge have been expanded (Kirby, 2023).
Figure 5
UNDERSTANDING
PERSONAL BIAS
Bias (Verb)
1. prejudice in favor of or against one thing, person, or
group compared with another, usually in a way
considered to be unfair. (OED, 2024)
Acknowledge you have bias
Practice mindfulness to prevent bias taking over
Take a Sexuality Attitude Reassessment (SAR)
Brooks, R. (1924).Una, Lady Troubridge (Oil on canvas)]. Queer Art
History. https://www.queerarthistory.com/category/transgendergender-non-conforming/
INSIDE ME OUTSIDE
ME DIRECTIVE
Part 110 minutes
Part 210 minutes
Materials
Materials
Sheet of paper
Drawing materials
1. Draw the outline of a figure from the
shoulders up.
2. Fill in the inside with all the parts that
make up who you are as an individual.
3. If you are comfortable, include your
relationships, sexuality, gender identity,
religion, race, interests, hobbies,
frustrations, challenges, etc.
Same sheet of paper
Drawing materials
1. Around the outside of your figure, draw the
‘professional’ version of yourself.
2. Include the following: How do you present
professionally? What information do you
share about yourself (both intentionally and
unintentionally)? What are the areas in
which you focus or specialize? How may a
client view you upon first encounter?
Processing
How much overlap is there
between the two spaces? Are there
areas where you would like more or
less overlap? Are there areas
where you may not acknowledge
how much your inner or outer self
bleed through? Could some of
these parts lead to bias or
assumptions towards clients?
Inspired by Coming Out Through
Art: A Review of Art Therapy with
LGBT Clients
Figure 6
LET’S TALK ABOUT SEX:
DISCUSSING SEX IN
SESSIONS
What to say? When to bring it up? What
information is important?
Start with yourself
Make it easier to bring up
Stay curious
Potential Tools to Utilize
Sexual Intake
Sexual Genogram
Kumari and king in coitus. Philadelphia Museum of Art. (n.d.).
https://philamuseum.org/collection/object/290427
Canva can be a great tool for virtual art therapy and co-creation or
genograms or other art forms as well as couples work
Art Directives
for Themes Related to
Sex Therapy
The following visuals are my own creations inspired by directives mentioned in a
variety of peer-reviewed articles and books.
A comprehensive list of the resources, will be provided in the resources handout.
JOINT VERBAL AND
NON-VERBAL DRAWING
Directive 1:
With your partner, each choose one drawing material and
put one sheet of paper between you both.
Decide who will begin.
Without speaking during the process, one person starts
and puts a mark on the paper.
The other person then creates a mark on the paper.
Continue taking turns until the artwork feels finished.
Debrief
INSPIRED METZL’S ART THERAPY WITH
COUPLES: INTEGRATING ART THERAPY
PRACTICES WITH SEX THERAPY AND
EMOTIONALLY FOCUSED THERAPY
Directive 2:
Rules are the same as directive 1, however, the two members are
allowed to talk during drawing.
Processing Questions:
What was the like for you both? Did anything surprise you?
Did anything frustrate you?
Were there any communication patterns that could be reflected in
your relationship?
SENSE BLACKOUT POEM
Inspired by Floyd’s The Use of
Poetry Therapy in Sex Therapy
Directive:
Based on Floyd’s example of a sense poem in
conjunction with a blackout poem.
Choose a book or article related to sex or themes the
client(s) are wanting to process.
Utilizing the senses, choose words that are associated
to the desired experience (sex was the experience in
the example)
Once the poem is complete, have the client add to the
image intuitively if desired.
(Black out poetry may not be necessary but can be a good
stepping stone for clients uncomfortable with fully writing
their own poetry)
Processing:
What came up as you tried to associate language with
this experience?
Was is easy? Difficult? Why do you think?
Did adding artwork intuitively add to or change this
experience?
SEXUAL IDENTITY
COLLAGE
Inspired by Coming Out Through
Art: A Review of Art Therapy with
LGBT Clients
Directive:
Create a collage
reflecting your
relationship and journey
with your own sexuality
and sexual exploration.
Processing:
What was this expereince
like?
Were you surprised?
Were there any images
you decided to add or
take away?
Is it finished?
What do you see when
viewing it?
FELTED GENITALIA
INSPIRED BY FERRANTO’S
VULVA EDUCATION THROUGH FIBER ARTS:
THE +CUNT PROJECT
Directive
Create genitalia (or any body part
desired) using felt or other fabric.
Processing
What was it like creating this artwork?
What surprised you about your
choices?
What is it like seeing it exist or holding
it in your hand?
BODY MAPPING
INSPIRED METZL’S ART THERAPY WITH COUPLES:
INTEGRATING ART THERAPY PRACTICES WITH SEX
THERAPY AND EMOTIONALLY FOCUSED THERAPY
Directive:
List words that come to mind regarding your body around sexual encounters
(define this as you prefer: individual or partnered encounters, positive,
negative, real or imagined, etc.).
Associate colors/patterns/ etc to each word.
Using a primate body outline or drawing your own, color the body with the
words chosen.
This may include but is not limited to placing words on physical locations
they are associated.
Work as intuintely and non-judgmentally as possible.
This can be done in an indecent or couples session.
Processing:
What came to mind as you chose your colors and words?
How did you utilize the colors on your artwork?
What came up as you created each layer?
What made you curious about the process and product?
FINAL DIRECTIVE
Materials:
Paper
Any media
Prompt:
Take the next 20 minutes to create a mixed media artwork in
response to this workshop and your own emotions.
Independent Processing:
What has come up? What was surprising or new? What
interests you?
Do you have any unresolved questions?
LIMITATIONS
Limited research available.
Limited CE/CEUs on the integration of the fields (Updated based on new
offering before the 2024 AATA conference).
Two known human sexuality for art therapists courses in existence.
Stigma around discussing sex and sexuality/knowing how to bring it up.
A sex-negative, heteronormative society with a taboo around sex.
Author’s own lack of training and professional in sex therapy and
integration of the two fields.
Research and testing of the workshop.
Figure7
AREAS FOR FUTURE
EXPLORATION/RESEARCH
Recommended that ACATE requires a human
sexuality for art therapists course as part of the
required art therapist training.
In addition to educational requirements, there
should be a push for the development of
CEs/CEUs on the integration of art therapy and
sex therapy.
Collet, J. (1779). An Actress at her toilet or Miss brazen just breecht [Paper and colored inks
(hand-colored)]. Queer Art History. https://www.queerarthistory.com/category/transgendergender-non-conforming/
FINAL THOUGHTS
There is an ethical and cultural need for more research and training on the integration of art therapy
and sex therapy. These therapies can be used to challenge systemic oppression which, if left
unchecked, can harm clients and their therapeutic process. Providing further education, training, and
research for therapists to integrate art therapy and sex therapy can grow both fields and encourage
comprehensive ethical practice for clinicians.
The goal of this workshop is to help clinicians feel empowered and encouraged to pursue further
training in these fields and request more opportunities for education and training.
AATA CONFERENCE 2024
Sunday, October 6, 2024, 9:00 AM - Sunday, October 6, 2024, 5:00 PM (USEST)
DEI117 - Establishing a Sex-Positive Therapeutic Approach to Encourage Healthy Sexuality and
Sexual Wellness
Led by: Daniel Blausey, Tamara Galinsky, Michaela Kirby
This course addresses the theory and practice of incorporating sexual wellness
in therapy through didactic and experiential methods. The course normalizes
sexuality discussions across participants’ lifespan, gender, and sexual
orientation in the context of culture, intersectionality, and mental health.
Additionally, participants examine historical sexual messaging, professional
comfort, and art-based interventions.
QUESTIONS?
THANK YOU!
RESOURCES FOR
FURTHER EDUCATION
AASECT
AATA
STAR
ATCB
Education opportunities specific to the
combination of art therapy and sex
therapy are limited. Reach out and
request more CE and educational
opportunities to AATA, AASECT,
STAR, ACATE, or your local chapters.
Art Therapy Literature that Includes
Directives for Sexuality/Sex Related Topics
When Art Therapy Meets Sex Therapy by Einat Metzl
Journal of the American Art Association, Volume 40, Issue 4 (2023)
This was a special issue centered on topics related to sexuality and
houses many of the resources and directives referenced in this
workshop.
Coming Out Through Art: A Review of Art Therapy with LGBT Clients by
Laura Pelton-Sweet and Alissa Sherry
Art Therapy with Couples: Integrating Art Therapy Practices with Sex
Therapy and Emotionally Focused Therapy by Einat Metzl
The Use of Poetry Therapy in Sex Therapy by Ashley Floyd
Images Used in this Presentation
https://www.queerarthistory.com
https://philamuseum.org/collection/curated/queer-art-collection
Linked Resources
Implicit BiasSAR
CDC Sexual Intake Recommendation
Recommended Literature
When Art Therapy Meets Sex Therapy by Einat Metzl
Ace by Angela Chen
Polywise & Polysecure by Jessica Fern
The Leather Couch & Kink-Affirming PracticeAce by Stefani Goerlich
Mating in Captivity by Esther Perel
Art Therapy: Journal of the American Art Therapy Association
Newest journal centers on relevent topics related to this presentation
References
About art therapy. American Art Therapy Association. (2023, January 18).
https://arttherapy.org/about-art-therapy/
American Association of Sexuality Educators, counselors and therapists |. AASECT. (n.d.). https://www.aasect.org/
American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-ofethics.pdf?sfvrsn=55ab73d0_1
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association
American Psychological Association. (n.d.). APA Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/sexuality
Art Therapy Credentials Board. (2021). Code of ethics, conduct, and disciplinary procedures.https://atcb.org/wp-content/uploads/2020/07/ATCB-Code-of-Ethics-ConductDisciplinaryProcedures.pdf
Barsky, A. E. (2022). Sexuality- and Gender-Inclusive Genograms: Avoiding Heteronormativity
and Cisnormativity. Journal of Social Work Education, 58(2), 379–389. https://doi.org/10.1080/10437797.2020.1852637
Caffrey, C. (2022). Sex therapy. Salem Press Encyclopedia of Health.
Ferranto, J. (2023). Vulva Education Through Fiber Arts: The +cunt Project. Art Therapy: Journal of the American Art Therapy Association, 40(4), 220–224.
https://doi.org/10.1080/07421656.2023.2206778
Floyd, A. A. (2021). The use of poetry therapy in sex therapy. Sexual & Relationship Therapy, 36(1), 106–115. https://doi.org/10.1080/14681994.2019.1658865
Hays, D. G. (2020). Multicultural and Social Justice Counseling Competency Research: Opportunities for Innovation. Journal of Counseling &
Development, 98(3), 331–344. https://doi.org/10.1002/jcad.12327
Hectors, A. (2023). Homosexuality in the DSM: A Critique of Depathologisation and Heteronormativity. New Zealand Sociology, 38(1), 18–28.
Kirby, M. (2023). Integrating a Sex-Positive Approach in Art Therapy, Art Therapy, DOI: 10.1080/07421656.2023.2193599
Kumari and king in coitus. Philadelphia Museum of Art. (n.d.). https://philamuseum.org/collection/object/290427
Metzl, E. (2020). Art therapy with couples: integrating art therapy practices with sex therapy and emotionally focused therapy. International Journal of Art Therapy:
Inscape, 25(3), 143–149. https://doi.org/10.1080/17454832.2020.1774628
Metzl, E. S. (2017). When Art Therapy Meets Sex Therapy: Creative Explorations of Sex, Gender, and Relationships. Routledge/Taylor & Francis Group.
Oliver (2021). An ever growing list of sexualities & their definitions. Rainbow & Co. https://rainbowandco.uk/blogs/what-were-saying/sexuality-definitions
Oxford English Dictionary. Sexuality (2023). https://www.oed.com/
Pelton-Sweet LM, & Sherry A. (2008). Coming out through art: a review of art therapy with LGBT clients. Art Therapy: Journal of the American Art Therapy Association, 25(4),
170–
176.
Pierik, B. (2022). Patriarchal power as a conceptual tool for gender history. Rethinking History, 26(1), 71–92. https://doi.org/10.1080/13642529.2022.2037864
Queer art history. Queer Art History. (n.d.). https://www.queerarthistory.com/
Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. M., Sadler, J. Z., & Kendler, K. S. (2010). What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychological Medicine,
40(11), 1759–1765. doi:10.1017/S0033291709992261
World Health Organization (WHO). (n.d). Sexual health. WHO. https://www.who.int/health-topics/sexual-health#tab=tab_1
Zeiger, K. D., & Ball, M. A. (2022). How the Compulsory Gender Binary Language in the DSM-5’s Category of Sexual Interest Disorders Interacts Negatively with Patients’
Nonbinary
and Genderqueer Identities. Sexuality & Culture, 26(4), 1531–1539. https://doi.org/10.1007/s12119-022-09950-0
AN ART THERAPY WORKSHOP
TO INCREASE THERAPEUTIC
ATTUNEMENT
PRESENTED BY: MOLLY HURD
APRIL 22, 2024
AREAS OF NOTE
All of the images used in this workshop are either pulled from queer affirming art history sites,
were showcased in museums for shows highlighting artists and subject matter relating to sex,
sexuality, or queerness, or are my own.
If any of these images interest you, I would encourage you to explore them further through the
resource list.
I primarily utilized existing institutions within the United States when referencing resources and
education opportunities for this presentation. This is because it is the information that was most
accessible and familiar. It’s important to note that this presentation is heavily westernized and norms
regarding art therapy and sex therapy are based on United States standards.
This presentation is not comprehensive and I encourage you to take note and further explore areas
that peak your curioisity.
PURPOSE
STATEMENT
Figure 1
The purpose of this research paper is to
develop a workshop curriculum to introduce
mental health clinicians to the relevance and
importance of integrating art therapy and sex
therapy while providing an introduction to
accessing further training and resources.
(N/A). German image of St. Wilgefortis (N/A)]. Queer Art History.
https://www.queerarthistory.com/category/transgender-gender-nonconforming/
JUSTIFICATION
ATCB
1.1.6 Art therapists must not engage in therapy
practices or procedures that are beyond their
scope of practice, experience, training, and
education.
1.2.4 Art therapists shall develop and improve
multicultural competence through ongoing
education and training. Art therapists shall use
practices in accordance with the client’s or group’s
age, gender, gender identity, gender expression,
sexual orientation, ethnicity, race, national origin,
culture, marital/partnership status, language
preference, socioeconomic status,
immigration/citizenship status, ability,
religion/spirituality, or any other identity factor.
Both fields are unique in structure and have the ability to
skirt around the often limiting structures of mental health
care. Western mental health care has historically been
weaponized against people who do not fit in a sexual norm
constructed by a patriarchal society (Pierik, 2022) . Due to
this, the use of art therapy with sex therapy can provide a
radical space for non-oppressive and comprehensive
mental health care.
TERMINOLOGY
Let’s get on the same page
Art Therapy- “Uses active art-making, the creative process, and
applied psychological theory—within a psychotherapeutic
relationship—to enrich the lives of individuals, families, and
communities” (AATA, para. 3).
Directive- An art prompt used in art therapy and for art as therapy.
Art Therapist- “Mental health clinicians with Master’s degrees or
higher that serve clients in different settings—from medical
institutions and schools, to wellness centers and independent
practices” (AATA, 2023, para. 4).
Sexuality- A person's identity in relation to the gender or genders to
which they are (or are not) typically attracted to.
Sex Therapy- “Any type of psychotherapy that addresses a
person’s sexual problems” (Caffrey, 2022).
Sex Therapist- Help clients understand their own sexual needs
concerning their mind and body and how to develop healthy sexual
practices and relationships. Although sex therapy has a significant
focus on sex, a sex therapists cover a much broader range of the
human experience than exclusively sex (AASECT, 2024).
Sex- Physical contact between individuals involving sexual
stimulation; sexual activity or behavior (OED, 2023).
Bias- Prejudice in favor of or against one thing, person, or group
compared with another, usually in a way considered to be unfair.
(OED, 2024)
LITERATURE REVIEW
Relationship between Art Therapy and Sex Therapy
Person Centered Theory
Relationship and client driven
Expressive Therapies Continuum (ETC)
Framework for AT
Attachment Theory
Identifies themes that encourage or discourage attachment at a young age (Hutchinson, 2023).
Emotionally Focused Therapy (EFT)
EFT has three stages: de-escalation, changing interaction patterns, and consolidation and integration
(Caffrey, 2023), and is structured based on Attachment Theory.
LITERATURE REVIEW
Multicultural and Social Justice Counseling Competency
(1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling
and advocacy interventions.
Weaponized Sexual Norms Throughout Society and Mental Health Care
Patriarchal Power (Pierik, 2022)
History of homosexuality in the DSM (Hectors, 2023)
Cultural Significance of Integrating Art Therapy and Sex Therapy
Integrating a sex-positive approach in Art Therapy (Kirby, 2023)
“Visual expressions rather than the role of the greater visual culture in shaping clients’
perspectives and creating internalized oppression” (Talwar, 2010)
LITERATURE REVIEW
Sexuality and Gender Explored Through Art Therapy
Somatic art therapy to explore and affirm LGBTQIA+ identity
Art therapy for coming out
Couples and Art Therapy
Metzl utilized EFT and expressive sex therapy as a framework while integrating art therapy with
couples
Art based directives in a Swedish counseling system for couples- couples art therapy through
government funding (Fjellfeldt & Rokka, 2022)
Use of poetry therapy in sex therapy (Floyd, 2021)
Available Sex Therapy Education for Art Therapists
2 separate human sexuality for art therapists elective courses (Metzl, 2013) and (Kirby, 2023)
Figure 2
WORKSHOP
STRUCTURE
First Half (85 minutes)
Relationship between Art Therapy and Sex Therapy
Terminology
Social Justice in Therapy
Historical Awareness
Understanding Bias
Ethics and Scope
10 minute break
Second Half (85 minutes)
Talking about sex and sexuality in sessions
Art Therapy directive for topics of sex/sexuality
Høeg, M. (1895-1903). [Photograph]. Queer Art History.
https://www.queerarthistory.com/category/transgendergender-non-conforming/
This is an interactive workshop and will include several art therapy
directives as well as digital engagement. Please be in a location
where you feel safe enough to fully engage and create.
WHO IS THIS WORKSHOP FOR?
Everyone! No matter the demographic you work with, sex and sexuality are human experiences that
shape the clients we work with and ourselves!
It’s important to note that the directives discussed in this workshop were
pulled from art therapists and should only be used by trained art therapists.
Many of these directives can be utilized as a form of art as therapy for clients
to process emotions, but non-art therapists should seek further training and
certifications to practice within their scope.
“Even art therapists who do not wish to operate as sex therapists or specialize in this
topic can and should consider the ways that the art interventions they already use
might support clients’ wellbeing while they more directly acknowledge their clients’
sexuality”
When Art Therapy Meets Sex Therapy
Einat Metzl, 2017
1 MINUTE DIRECTIVE
DRAW A SMILE FACE
Materials:
Notecard of sheet of paper
Any drawing material
Prompt:
Quickly draw a smile face on your sheet of paper.
PROCESSING
Hold up your smile face. Are any the exact
same? Any different? How may of you
associated the smile face with an emoji? A
symbol from your childhood? Or a cultural
norm?
Here are a few! This list is not comprehensive.
All responses are
anonymous
Scan the QR code
Figure 4
WHY SOCIAL JUSTICE
IS IMPORTANT FOR
ART AND SEX
THERAPY
The World Health Organization (WHO) defines sexual
health as “fundamental to the overall health and
wellbeing of individuals, couples, and families, and the
social and economic development of communities and
countries” (World Health Organization [WHO], n.d., para.1).
(N/A). Portrait of We’wha Holding a Clay Ceremonial Prayer-Meal
Basket (hand-colored)]. Queer Art History.
https://www.queerarthistory.com/category/transgender-gender-nonconforming/
SOCIAL JUSTICE: THE WHY AND HOW
Pierik defines Patriarchal Power as “men’s appropriated power over the flesh, over
biological processes but also the knowledge and appearances of these processes, which
results in it presenting itself as the ‘natural’ default state, and women’s challenge to it as
unnatural and against biology.” (Pierik, 2022).
Working from a social justice lens encourages broader perspective taking and cultural
competency.
Creating space to safely voice societal inequities can empower clients to recognize
external factors that impact them.
Working from a multicultural lens provides varied viewpoints and understanding of self
and society.
Both awareness and understanding are intended to be an ongoing responsibility to
challenge clinicians to recognize their own bias, educate themselves on the elements
of human sexuality (both physically and emotionally), and identify the social rules that
dictate sexual norms. Skills can be approached once a clinician’s self-awareness and
knowledge have been expanded (Kirby, 2023).
Figure 5
UNDERSTANDING
PERSONAL BIAS
Bias (Verb)
1. prejudice in favor of or against one thing, person, or
group compared with another, usually in a way
considered to be unfair. (OED, 2024)
Acknowledge you have bias
Practice mindfulness to prevent bias taking over
Take a Sexuality Attitude Reassessment (SAR)
Brooks, R. (1924).Una, Lady Troubridge (Oil on canvas)]. Queer Art
History. https://www.queerarthistory.com/category/transgendergender-non-conforming/
INSIDE ME OUTSIDE
ME DIRECTIVE
Part 110 minutes
Part 210 minutes
Materials
Materials
Sheet of paper
Drawing materials
1. Draw the outline of a figure from the
shoulders up.
2. Fill in the inside with all the parts that
make up who you are as an individual.
3. If you are comfortable, include your
relationships, sexuality, gender identity,
religion, race, interests, hobbies,
frustrations, challenges, etc.
Same sheet of paper
Drawing materials
1. Around the outside of your figure, draw the
‘professional’ version of yourself.
2. Include the following: How do you present
professionally? What information do you
share about yourself (both intentionally and
unintentionally)? What are the areas in
which you focus or specialize? How may a
client view you upon first encounter?
Processing
How much overlap is there
between the two spaces? Are there
areas where you would like more or
less overlap? Are there areas
where you may not acknowledge
how much your inner or outer self
bleed through? Could some of
these parts lead to bias or
assumptions towards clients?
Inspired by Coming Out Through
Art: A Review of Art Therapy with
LGBT Clients
Figure 6
LET’S TALK ABOUT SEX:
DISCUSSING SEX IN
SESSIONS
What to say? When to bring it up? What
information is important?
Start with yourself
Make it easier to bring up
Stay curious
Potential Tools to Utilize
Sexual Intake
Sexual Genogram
Kumari and king in coitus. Philadelphia Museum of Art. (n.d.).
https://philamuseum.org/collection/object/290427
Canva can be a great tool for virtual art therapy and co-creation or
genograms or other art forms as well as couples work
Art Directives
for Themes Related to
Sex Therapy
The following visuals are my own creations inspired by directives mentioned in a
variety of peer-reviewed articles and books.
A comprehensive list of the resources, will be provided in the resources handout.
JOINT VERBAL AND
NON-VERBAL DRAWING
Directive 1:
With your partner, each choose one drawing material and
put one sheet of paper between you both.
Decide who will begin.
Without speaking during the process, one person starts
and puts a mark on the paper.
The other person then creates a mark on the paper.
Continue taking turns until the artwork feels finished.
Debrief
INSPIRED METZL’S ART THERAPY WITH
COUPLES: INTEGRATING ART THERAPY
PRACTICES WITH SEX THERAPY AND
EMOTIONALLY FOCUSED THERAPY
Directive 2:
Rules are the same as directive 1, however, the two members are
allowed to talk during drawing.
Processing Questions:
What was the like for you both? Did anything surprise you?
Did anything frustrate you?
Were there any communication patterns that could be reflected in
your relationship?
SENSE BLACKOUT POEM
Inspired by Floyd’s The Use of
Poetry Therapy in Sex Therapy
Directive:
Based on Floyd’s example of a sense poem in
conjunction with a blackout poem.
Choose a book or article related to sex or themes the
client(s) are wanting to process.
Utilizing the senses, choose words that are associated
to the desired experience (sex was the experience in
the example)
Once the poem is complete, have the client add to the
image intuitively if desired.
(Black out poetry may not be necessary but can be a good
stepping stone for clients uncomfortable with fully writing
their own poetry)
Processing:
What came up as you tried to associate language with
this experience?
Was is easy? Difficult? Why do you think?
Did adding artwork intuitively add to or change this
experience?
SEXUAL IDENTITY
COLLAGE
Inspired by Coming Out Through
Art: A Review of Art Therapy with
LGBT Clients
Directive:
Create a collage
reflecting your
relationship and journey
with your own sexuality
and sexual exploration.
Processing:
What was this expereince
like?
Were you surprised?
Were there any images
you decided to add or
take away?
Is it finished?
What do you see when
viewing it?
FELTED GENITALIA
INSPIRED BY FERRANTO’S
VULVA EDUCATION THROUGH FIBER ARTS:
THE +CUNT PROJECT
Directive
Create genitalia (or any body part
desired) using felt or other fabric.
Processing
What was it like creating this artwork?
What surprised you about your
choices?
What is it like seeing it exist or holding
it in your hand?
BODY MAPPING
INSPIRED METZL’S ART THERAPY WITH COUPLES:
INTEGRATING ART THERAPY PRACTICES WITH SEX
THERAPY AND EMOTIONALLY FOCUSED THERAPY
Directive:
List words that come to mind regarding your body around sexual encounters
(define this as you prefer: individual or partnered encounters, positive,
negative, real or imagined, etc.).
Associate colors/patterns/ etc to each word.
Using a primate body outline or drawing your own, color the body with the
words chosen.
This may include but is not limited to placing words on physical locations
they are associated.
Work as intuintely and non-judgmentally as possible.
This can be done in an indecent or couples session.
Processing:
What came to mind as you chose your colors and words?
How did you utilize the colors on your artwork?
What came up as you created each layer?
What made you curious about the process and product?
FINAL DIRECTIVE
Materials:
Paper
Any media
Prompt:
Take the next 20 minutes to create a mixed media artwork in
response to this workshop and your own emotions.
Independent Processing:
What has come up? What was surprising or new? What
interests you?
Do you have any unresolved questions?
LIMITATIONS
Limited research available.
Limited CE/CEUs on the integration of the fields (Updated based on new
offering before the 2024 AATA conference).
Two known human sexuality for art therapists courses in existence.
Stigma around discussing sex and sexuality/knowing how to bring it up.
A sex-negative, heteronormative society with a taboo around sex.
Author’s own lack of training and professional in sex therapy and
integration of the two fields.
Research and testing of the workshop.
Figure7
AREAS FOR FUTURE
EXPLORATION/RESEARCH
Recommended that ACATE requires a human
sexuality for art therapists course as part of the
required art therapist training.
In addition to educational requirements, there
should be a push for the development of
CEs/CEUs on the integration of art therapy and
sex therapy.
Collet, J. (1779). An Actress at her toilet or Miss brazen just breecht [Paper and colored inks
(hand-colored)]. Queer Art History. https://www.queerarthistory.com/category/transgendergender-non-conforming/
FINAL THOUGHTS
There is an ethical and cultural need for more research and training on the integration of art therapy
and sex therapy. These therapies can be used to challenge systemic oppression which, if left
unchecked, can harm clients and their therapeutic process. Providing further education, training, and
research for therapists to integrate art therapy and sex therapy can grow both fields and encourage
comprehensive ethical practice for clinicians.
The goal of this workshop is to help clinicians feel empowered and encouraged to pursue further
training in these fields and request more opportunities for education and training.
AATA CONFERENCE 2024
Sunday, October 6, 2024, 9:00 AM - Sunday, October 6, 2024, 5:00 PM (USEST)
DEI117 - Establishing a Sex-Positive Therapeutic Approach to Encourage Healthy Sexuality and
Sexual Wellness
Led by: Daniel Blausey, Tamara Galinsky, Michaela Kirby
This course addresses the theory and practice of incorporating sexual wellness
in therapy through didactic and experiential methods. The course normalizes
sexuality discussions across participants’ lifespan, gender, and sexual
orientation in the context of culture, intersectionality, and mental health.
Additionally, participants examine historical sexual messaging, professional
comfort, and art-based interventions.
QUESTIONS?
THANK YOU!
RESOURCES FOR
FURTHER EDUCATION
AASECT
AATA
STAR
ATCB
Education opportunities specific to the
combination of art therapy and sex
therapy are limited. Reach out and
request more CE and educational
opportunities to AATA, AASECT,
STAR, ACATE, or your local chapters.
Art Therapy Literature that Includes
Directives for Sexuality/Sex Related Topics
When Art Therapy Meets Sex Therapy by Einat Metzl
Journal of the American Art Association, Volume 40, Issue 4 (2023)
This was a special issue centered on topics related to sexuality and
houses many of the resources and directives referenced in this
workshop.
Coming Out Through Art: A Review of Art Therapy with LGBT Clients by
Laura Pelton-Sweet and Alissa Sherry
Art Therapy with Couples: Integrating Art Therapy Practices with Sex
Therapy and Emotionally Focused Therapy by Einat Metzl
The Use of Poetry Therapy in Sex Therapy by Ashley Floyd
Images Used in this Presentation
https://www.queerarthistory.com
https://philamuseum.org/collection/curated/queer-art-collection
Linked Resources
Implicit BiasSAR
CDC Sexual Intake Recommendation
Recommended Literature
When Art Therapy Meets Sex Therapy by Einat Metzl
Ace by Angela Chen
Polywise & Polysecure by Jessica Fern
The Leather Couch & Kink-Affirming PracticeAce by Stefani Goerlich
Mating in Captivity by Esther Perel
Art Therapy: Journal of the American Art Therapy Association
Newest journal centers on relevent topics related to this presentation
References
About art therapy. American Art Therapy Association. (2023, January 18).
https://arttherapy.org/about-art-therapy/
American Association of Sexuality Educators, counselors and therapists |. AASECT. (n.d.). https://www.aasect.org/
American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-ofethics.pdf?sfvrsn=55ab73d0_1
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association
American Psychological Association. (n.d.). APA Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/sexuality
Art Therapy Credentials Board. (2021). Code of ethics, conduct, and disciplinary procedures.https://atcb.org/wp-content/uploads/2020/07/ATCB-Code-of-Ethics-ConductDisciplinaryProcedures.pdf
Barsky, A. E. (2022). Sexuality- and Gender-Inclusive Genograms: Avoiding Heteronormativity
and Cisnormativity. Journal of Social Work Education, 58(2), 379–389. https://doi.org/10.1080/10437797.2020.1852637
Caffrey, C. (2022). Sex therapy. Salem Press Encyclopedia of Health.
Ferranto, J. (2023). Vulva Education Through Fiber Arts: The +cunt Project. Art Therapy: Journal of the American Art Therapy Association, 40(4), 220–224.
https://doi.org/10.1080/07421656.2023.2206778
Floyd, A. A. (2021). The use of poetry therapy in sex therapy. Sexual & Relationship Therapy, 36(1), 106–115. https://doi.org/10.1080/14681994.2019.1658865
Hays, D. G. (2020). Multicultural and Social Justice Counseling Competency Research: Opportunities for Innovation. Journal of Counseling &
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Hectors, A. (2023). Homosexuality in the DSM: A Critique of Depathologisation and Heteronormativity. New Zealand Sociology, 38(1), 18–28.
Kirby, M. (2023). Integrating a Sex-Positive Approach in Art Therapy, Art Therapy, DOI: 10.1080/07421656.2023.2193599
Kumari and king in coitus. Philadelphia Museum of Art. (n.d.). https://philamuseum.org/collection/object/290427
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Media of