Alice Walker said, “Sexuality is one of the ways that we become enlightened, actually, because it leads us to self-knowledge.” But what happens when sexuality becomes a site of pain and trauma? For far too many people, harmful experiences can limit the benefits that healthy sexuality can bring.

RAINN (Rape, Abuse & Incest National Network) reports that one in six American women — and one in 33 men — experiences an attempted or completed rape. The federal Office for Victims of Crimes reports that one in two transgender people are sexually assaulted.

Sexual assault may be the most obvious way that people experience harm around sexuality, but it is far from the only way.

“Many of us have been deeply shamed and hurt about how we feel about the bodies we live in, the sex we desire, the sex we have settled for, and our beliefs and opinions about sex in general,” said therapist Jassy Casella Timberlake. “Hardly any of us have escaped our sex-negative world unscathed.”

“Sex therapy can be healing because some of the earliest experiences of shame and oppression occur before or during puberty and center around a person’s body, sexuality and sexual practices,” said therapist Shannon Sennott. “Sex therapy is often early trauma work.”

Such experiences can lead people to sex therapy, but often these same experiences get in the way of seeking that help.

“I think sex therapy is stigmatized somewhat in popular culture,” said therapist L. Davis Chandler.

“Clients tell me that they’ve often made several attempts to pluck up courage to call, or that it took a lot to walk through the door and sit in the waiting room,” said Timberlake.

“Sex and sexuality are very confusing and that makes a lot of people very nervous,” said therapist Brooke Norton. “People often wait to go to therapy until things are really bad.”

In fact, renowned psychologist John Gottman reported in 1994 that the average couple waits six years before seeking help.

“I really enjoy helping couples or folks within polyamorous relationships work on their long-term goals for their sex lives — yet when they get here, they’re really stuck,” said Norton. “I can bring hope into the situation. It’s very gratifying to see folks figure out want they want and need.”

The Northampton area has a number of experienced sex therapists — Psychology Today lists 32 clinicians who offer sex therapy. Timberlake is one of the most established, with 15 years of experience as a certified sex therapist. She founded Northampton Sex Therapy, LLC, based in Florence, in 2010 and provides supervision to other sex therapists. In downtown Northampton, Chandler and Sennott, both graduates of the Smith College School for Social Work, see clients at the Center for Psychotherapy and Social Justice. Norton works with individuals, couples and families in Florence — and is currently at work on a book, as well.

“Some issues that bring people to sex therapy are related to feeling that they can’t function sexually, alone or in a partnership,” said Timberlake. “This may be because of anxiety which impacts erectile and ejaculatory functionality, sexual pain disorders that get in the way of enjoying sex, desire discrepancy or differences in sexual style in a partnership.”

The acronym PLISSIT guides sex therapists in determining how to help a client. Devised in 1976 by psychologist Jack S. Annon, the model includes Permission, Limited Information, Specific Suggestions, and Intensive Therapy.

“Some people are hampered by feelings of guilt — for example, about the idea of self-pleasuring — and having a sex therapist validate this as a legitimate and acceptable sexual health practice can alleviate those feelings,” said Timberlake. “Providing limited information can help dispel myths that a person may have about sex and their own sexual health, while specific suggestions might address how to enhance a client’s sexual experience, particularly if they are having difficulty with issues around performance, communication and anxiety.”

For many clients, those steps are all that are needed to resolve the problems they are having. According to Timberlake, those cases may require only three to six months of treatment.

For those affected by trauma, however, treatment may require the fourth option in the PLISSIT model.

“Intensive therapy is far more in-depth,” said Timberlake. “It means inquiring into a client’s sexual history, their medical and medication history, and addresses any trauma present that may be complicating their sexual functioning.”

“Sexual trauma always adds a layer of complexity and time to the length of treatment,” said Timberlake. “People sometimes show up in sex therapy in the immediate aftermath of a sexual assault, but often trauma survivors tend to work with generalist therapists initially. They may seek sex therapy once trauma responses have become more manageable and they are able to focus more on healing their sexual lives.”

“It’s never too soon or too late to get help,” said Norton. “There is a shift in the brain that occurs about 90 days after a trauma happens, and the process is different for helping those with new trauma versus old trauma. The ideal time is as soon as someone is ready to seek treatment — and there are therapies that don’t require people to talk about what happened. We don’t have to delve into long explanations in order for things to change. We can process memories in a few different ways — talking is just one of them.”

Often the issues that bring someone to therapy are not the only factors at play in their treatment.

“Many clients present with desire discrepancy as an issue, but with co-occurring sexual problems related to medical issues, such as cancer, auto-immune disorders, sexual pain issues, visible and invisible disabilities, etc.,” said Timberlake. “I love working with people who are addressing issues of aging and how living in an aging body impacts their desire and functionality.”

“I work with people when they are in current medical treatment and I also work with folks who are getting generalized therapy — and I work with people who are not in either of those circumstances,” said Norton.

Timberlake’s sex therapy practice is about 50 percent couples and polycules (polyamorous relationship units) — and includes people who identify as LGBTQ or heterosexual, cisgender or transgender/non-binary.

Sennott’s clients are similarly diverse, including couples, polycules, and families in a variety of relationship structures.

“I’m especially interested in sexuality and sexual practices of people who identify as queer, poly, trans, nonbinary, people of size, and people with visible or invisible disabilities,” said Sennott.

As a nonbinary and trans-identified therapist, Chandler is passionate about providing therapy to people who are marginalized based on gender and sexual identities or relationship practices.

For people interested in exploring sex therapy, Timberlake recommends seeking a professional who is board-certified by the American Association for Sex Educators, Counselors and Therapists (AASECT) or being supervised by a board-certified sex therapist. Since AASECT certification is not required to call oneself a sex therapist, those who aren’t certified range considerably in training and experience.

“If in doubt, ask what specific training a therapist has had that informs their treatment protocols — and don’t be satisfied with a three-hour training or workshop as the answer,” Timberlake said.

Ultimately, the right sex therapist is one with whom a client is comfortable enough to be vulnerable and feel supported in that process.

“Anyone and everyone could benefit from therapy that includes topics of sex and sexuality,” said Chandler. “Sex is relevant to everyone — even folks who aren’t having it.”

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