What I Wish We Learned About Sex : A Compass for Healthy Sexuality
By Mike Fuller
If you had told me twenty years ago that I would one day be presenting and writing as a licensed social worker and certified sex therapist-in-training, I would have found it hard to believe. My journey took me from a lengthy career as a full-time seminary teacher for the LDS Church to obtaining a social work degree from Penn West University, and ultimately diving headfirst into the complex world of sex therapy. Through all these transitions—professional, personal, and philosophical—the one most profound realization I have had is this: we are desperately undereducated, as therapists and as humans, when it comes to sex, sexuality, and healthy sexual relationships.
This essay is the synthesis of what I wish every therapist; and by extension, every person; had learned about sex, sexuality, and therapy. It is rooted in my lived experience, the deep education I continue to receive, and the ongoing dialogue with clients who often show up with shame, silence, or confusion around these topics.
The Inadequacy of Traditional Sexual Education
Like many of you, my education around sex was rooted in what I call the “belief-based decision-making model.” The religious institution that had shaped most of my worldview also set the parameters for what counted as moral, ethical, or even discussable about sex. Sex was either sacred or sinful, clean or dirty, marital or shameful—rarely anything in between. Messages were implicit: silence was a virtue, ignorance was protection, and curiosity, especially outside rigid boundaries, was dangerous.
It was only through professional training in social work and sex therapy—especially with the AASECT certification process and learning from the likes of Doug Braun-Harvey and Emily Nagoski—that I began to appreciate the dramatic gap between what most therapists are prepared for and what our clients actually need. This gap isn’t just theoretical; it directly impacts our clients’ mental and physical health, the quality of their relationships, and their ability to feel at home in their own bodies.
So what’s missing? I now believe we all—therapists, clients, and communities—need a practical, values-based, non-shaming framework for healthy sexuality. We need the skills, language, and confidence to talk about sex without embarrassment or avoidance. Above all, we need to replace the patchwork of fearful, moralizing messages with something affirming, concrete, and liberating.
The Frameworks: Biopsychosocial and PLISSIT Models
Before diving into the core of my approach, I want to quickly review two models foundational to sex therapy.
First: The biopsychosocial model. Whether it’s sexual issues or otherwise, we must take into account biological, psychological, and social factors. As therapists, we should be comfortable investigating medical contributors to sexual issues (hormonal imbalances, pain disorders, medication effects), psychological contributors (trauma, anxiety, depression, relationship dynamics), and social contributors (cultural stigma, minority stress, etc.).
Second: The PLISSIT Model. Permission, Limited Information, Specific Suggestions, Intensive Therapy. As clinicians, we should strive to create explicit permission for clients to talk about sex, provide limited but accurate information when appropriate, offer direct suggestions when qualified, and refer clients for intensive sex therapy when an issue is beyond our scope. This simple framework dramatically increases the odds that a sexual issue—so often left buried in silence—is actually identified and addressed in therapy.
The Need for a New Compass
But here’s the thing: models and frameworks are only as helpful as the real-world, values-based principles behind them. Historically, we viewed “sexual health” as merely “the absence of problems.” If you weren’t getting STIs or unwanted pregnancies, you were “fine.” But that’s a deeply limited perspective. We need to think in terms of thriving, not merely surviving.
This is why I have built, borrowed, and synthesized what I call the “Sexual Health Compass.” It’s an acronym—because that’s how my brain works!—and it incorporates core principles developed at the Harvey Institute (with my own additions). This Compass is something I wish every therapist, partner, parent, and individual could use to navigate the messy, wonderful, sometimes confusing terrain of sex.
1. Consent
Let’s start with consent, the north star of our compass. Consent is always voluntary, reversible, informed, enthusiastic, and specific (FRIES for short). It isn’t just a checkbox; it’s a litmus test for respect and safety.
Many of us, myself included, grew up in environments where the messages about consent were ambiguous at best (“your clothing is your consent”), coercive at worst (“women should submit to men”), or just plain absent. Too many were taught to say yes to avoid being rude, or that “no” means “try harder.” In my own counseling practice, I’ve encountered clients—especially those raised female—who never realized it was okay to refuse unpleasurable touch, or who didn't know how to attune to their own yes/no/maybe.
Teaching clients and ourselves to fully internalize consent means repeatedly affirming the right to give and revoke consent at any time, for any reason. We must help clients recognize the subtle cues and bodily signals of true consent in themselves and in their partners, and we must be direct in holding ourselves and others accountable for respecting boundaries.
2. Openness (Honesty & Vulnerability)
The “O” in my compass stands for openness, a blend of honesty and vulnerability. Sexual health requires open and direct communication with oneself and every sexual partner. And yet, how many of us were taught the opposite? I’ve heard from countless clients: “You must never talk about your sexual past,” “faking orgasms is normal,” or “one shouldn’t even be openly sexual, let alone honest about it.”
Openness is about embracing the reality that every person has their own sexuality—including private fantasies, desires, and fears—and that secrecy breeds loneliness, shame, and ultimately disconnection. As therapists, we can help clients see the difference between honesty and radical transparency. It’s okay for people to have private sexual thoughts; not every fantasy or private desire needs disclosure. But openness with partners—about needs, preferences, and boundaries—creates trust and intimacy.
Clients often fear rejection if they reveal a specific desire. More often than not, I’ve witnessed enormous relief and deeper connection when a client finally shares a vulnerable truth, only to be met (sometimes with surprise) by openness and curiosity from their partner.
3. Mutual Pleasure
Another essential point on the compass is mutual pleasure—an area where cultural messages regularly fail us. For many women, messages from religious or cultural authorities implied that sex was about men’s pleasure, and that women’s experiences didn’t count or were even non-existent. Clients internalized shame around masturbation, pleasure, or desire, or were simply never taught it mattered.
A healthy sexuality model emphasizes that pleasure is not just permissible but essential. True sexual well-being involves pleasure for all parties. As Emily Nagoski so convincingly writes, “Pleasure is the measure.” If you don’t enjoy the sex you’re having, something isn’t working—not with you, but with the circumstances, context, or lack of communication.
Therapists can play a crucial role in moving clients away from a “performance-based” model of sex (orgasm as the goal, routines as proof of success, anxiety about measuring up), toward a “pleasure-based” or “embodiment-based” model (authentic enjoyment, exploration, presence, and acceptance of various outcomes). This involves teaching clients to recognize and explore “accelerators” and “brakes” (using Nagoski’s dual control model) and the difference between “responsive” and “initiating” desire.
4. Prevention & Protection
Safety is not just about physical harm, although that’s certainly critical. Sexual health also means actively preventing unwanted consequences: STIs, infections, and pregnancies. But messages here are often unhelpful too—ranging from “abstinence only” and “pregnancy is punishment” to silence about practical protection.
Clients need encouragement and practical tools: getting tested regularly, discussing contraception, managing body fluids, and having “TLC kits” (Toys, Lubes, Condoms/Cleanups) available. Therapists should be comfortable prompting conversations about these topics and normalizing them as part of a healthy life. We also need to help clients recalibrate their sense of what defines “prevention” and “protection,” especially if abstinence or avoidance was the only option ever discussed.
5. Autonomy (Non-Exploitation)
Autonomy means owning your sexuality, free from the power or control of others. All forms of exploitation—whether physical (violation of consent), or verbal/relational (dishonesty, manipulation, failure to keep agreements)—undermine not only relationships, but the foundation for personal integrity.
A client who withholds information about their sexual behaviors, cheats, or manipulates a partner’s perception is being exploitive, consciously or not. Part of our job as therapists is to name this for what it is—not in a shaming way, but to help clients commit to authentic, mutually respectful sexual experiences.
6. Shared Values
Sex does not happen in a moral vacuum. Every person brings to the table values—often inherited unconsciously from religious, medical, or media sources. Whether it’s “sex is for marriage only,” “marriage means heterosexuality,” “sex is dirty unless...,” or “if you don't follow the rules you’re bad”—these values often create confusion, conflict, or distress, especially when a client’s lived experiences don’t match the rigid messages they were given.
The work here is to help clients articulate what they want their sexual values to be, now—not just what they were taught. Some may embrace the principles outlined here as their new sexual values: consent, mutual respect, pleasure, safety, autonomy. It’s important for clients (and ourselves) to have conscious, chosen values—ones that foster personal growth and respect, rather than shame and restriction.
7. Safety (Balancing Pleasure and Risk)
Finally, all these principles together must balance safety and risk. Healthy sexuality is never entirely risk-free; it’s about being intentional and informed in the choices we make. Balancing the deep human need for intimacy, pleasure, and connection with the equally deep need for respect, security, and freedom is core to the work of sex therapy.
Translating the Compass Into Practice
How do we use this compass? In session, it often looks like this:
Asking clients where they learned their messages about sex (from the “three Ms”: Moral, Medical, Media).
Helping them identify negative or limiting messages and consciously choose what they want to keep, discard, or replace.
Coaching clients on how to discuss these topics with partners: “What’s pleasurable for you? What’s not? How do you know when your partner consents? How can you talk about what you want without shame?”
Encouraging clients to explore solo pleasure as a healthy foundation for partnered intimacy.
Challenging secrecy, shame, and avoidance with curiosity, education, and compassion.
In my own practice, I use acronyms, concrete tools, and direct questions because it lowers the barrier for discussion, makes the intangible tangible, and helps clients quickly pinpoint where an issue lies. “Sounds like this is a consent question;” “This seems to be about mutual pleasure;” “Let’s clarify your values together.”
Conclusion: From Surviving to Thriving
To be a great therapist is, in my view, to model comfort, curiosity, and courage around sexuality. Sex—broadly defined—deserves our respect, our attention, and our best thinking. Clients show up in our offices hungry for validation, normalization, and practical tools to navigate sex in a world filled with mixed messages and taboos. Our job is to provide that in a way that’s grounded, affirmative, and adaptable to every client’s unique journey.
If I could wave a wand and re-do graduate education, I would require every therapist to learn the Sexual Health Compass—not as a unit or a module, but as an organizing principle for how we treat the entire human person. We all deserve to get past shame, silence, and secrecy, and move toward a sexuality abundant in pleasure, respect, freedom, and love.
References:
Doug Braun-Harvey
Emily Nagoski, "Come As You Are"
Modern Sex Therapy Institute
AASECT
Betty Martin, "The Three Minute Game"
Lucy Fielding, "Trans Sex"
