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The Business of Sex Therapy in 2023

COVID changed everything, and mental health professionals were certainly not exempt. The role mental health professionals (that is, therapist, psychologist, psychiatrists, etc.) played during the pandemic was invaluable…and certainly unique. As we move further from the quarantine days of 2020-2021, many aspects of mental health care continue to evolve, including how practitioners do the business of therapy. With June 9th being National Sex Day, and Council for Relationships being home to some of the best Sex Therapists in the field,  CFR’s Director of the Post Graduate Certificate Program in Sex Therapy, Dr. James Wadley, reflects on how he navigated the pandemic while also maintaining his practice, and provides an inside look into the business of sex therapy in 2023.

Pictured here is Alfred Kinsey in grey-scale wearinig a light blazer jacket, white shirt, and a dark bowtie. His arms are crossed and he is looking directly at the camera smiling.

Alfred Kinsey (pictured here) was a pioneering American Sexologist best known for developing the Heterosexual-Homosexual Rating Scale commonly known as the Kinsey Scale.

The Business of Sex Therapy During COVID

The COVID pandemic quarantine was difficult for many as it was an unanticipated global phenomenon that impacted families and communities. Confusion about wearing masks, vaccinations, distance between one another, and lots of information and misinformation made personal, relational, and familial decision making tough for everyone. As a sexuality therapist and practitioner, it was hard for me to think through how I could be “there” for my family as well as for my clients. Navigation through the unknown had a lot of physical, emotional, and even financial pitfalls. Up until the pandemic, I had never considered meeting with clients via telehealth but because of the high transmissibility of the virus, I decided to close my practice locations and begin to see clients from home.

Providing quality therapy from home while monitoring my youngest son’s experience of first grade via Zoom was challenging. Similar to most families experience of the quarantine, my partner and I’s experience of getting him to sit still, focus, and learn over the course of a school day was a daunting task. Like many of his classmates, he wiggled in his seat and found himself easily distracted by my cat, Waffles, who would frequently approach him at his desk (dinner table) for a treat. I worked from my laptop and offered my clients scores of apologies for family disruptions and intrusions and they were all very graceful and compassionate as we continued to work through relational, emotional, and sexual health issues. My clients’ identities were never revealed to anyone in my family as I continued to observe HIPAA standards, but for many therapists, it was hard to get into a good rhythm of setting spatial boundaries while working from home.

Picture of Ruth Westheimer wearing a red shirt with gold necklace and red glasses. She is looking directly at the camera and is smiling.

Famed Sex Therapist Ruth Westheimer (pictured here), often referred to simply as Dr. Ruth, is also a talk show host, author, and Holocaust survivor.

A Sex Therapist Ponders both Clinical and Business Questions

When there was down time over the quarantine, I had a chance to reflect upon my clinical and business experiences in the field. As a family systems therapist, I had always subscribed to the notion of “everyone should be in the room” during therapy in order to change the system. The system impacts individual and relational function and dysfunction. Good therapy is always done in person, face to face. Because of the quarantine, that model could no longer work as at one time; it was too dangerous to meet with clients in my office due to transmission of the virus. So I began to ponder and process the following three clinical questions:

  1. Will my clients be open to meeting with me via telehealth since there is no face-to-face contact?
  2. How will telehealth impact the work that I do as a therapist? Will I be able to successfully help my clients reach their goals?
  3. Will my internet be able to consistently sustain telehealth platforms?

I also pondered and processed a few business-related questions:

  1. Once I stop seeing clients in New Jersey or Pennsylvania at my office, should I continue to pay rent and will my landlord let me out of my lease?
  2. Will I pay for storage for my furniture? Who will help me move furniture during a pandemic and what are the costs for a moving company?
  3. How will my revenue fluctuate once I see clients via telehealth and how will that change affect my income and quality of living?

Picture of William Masters (right) and Virginia Johnson (left) in grey scale standing in front of a book case. Both Masters and Johnson are wearing white shirts and looking directly at the camera with neutral expressions.

Pictured here are William H. Masters (right) and Virginia E. Johnson (left), who pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual disorders and dysfunctions from 1957 until the 1990s.

The Business of Sex Therapy

I rented my Philadelphia office from 2007 until 2020. It wasn’t all that fancy, but I had a lot of pride because it was one of the first spaces where I was a completely independent as a professional. The cost of my space was $500 a month. My landlord never raised the rent and never made any repairs to the heat or air conditioning. My lease expired around 2009 and shifted to a “month- to-month” contractual arrangement. When I shared with my landlord that I wanted to close the office in 2020 due to the pandemic, he was grateful and thankful for the business relationship that we had over the years.

I packed up several boxes and gave away my office furniture to a local shelter. It was hard to let go of a lot of items (that is, books, knick-knacks, pictures, etc.) because it felt like a chapter in my life had ended. I continue to mourn the loss of the space because like most things in life, change was unanticipated but necessary.

Similarly, for my office in New Jersey, my landlord was relatively lenient and understanding about shifting our lease agreement— but he still wanted his money). He reduced my rent of $950 to $475. I was still responsible for the balance of the lease (about $12,000) when I moved out in 2020, but I was given an opportunity to pay less for the foreseeable future. Without knowing the amount of revenue that I would generate, I accepted it because I was able to save some money each month.

Between clients, helping my son with schoolwork, grieving the loss of my mother-in-law, and managing other aspects of the pandemic and quarantine, I thought about my lack of knowledge about business related concepts while working from home. I wish that I had taken at least one business course just so I could understand a few concepts so that I would not (figuratively) bump my head and have to pay a lot of money for my mistakes.

Picture of Patricia Schiller in grey scale. Schiller is in profile and is smiling.

Patricia Schiller (pictured here) founded the American Association of Sexuality Educators, Counselors and Therapists (AASECT) in 1967, the first professional organization for sexuality educators, sexuality counselors and sex therapists.

The Business of Sex Therapy in 2023 and Beyond?

With all the years of schooling and continuing education, I had no clue about developing a business. I felt disempowered but could only blame myself for not pushing myself over the years to learn more about the art of business.

Most clinical mental health, social work, wellness, and sexuality therapy programs do not have a business component as a part of their curriculum. It is unfortunate because there are many sexual and relational health and wellness practitioners who move into private or group practice; set up or work in a nonprofit; accept or create a “gig”; take an academic or administrative position at a college or university; become entrepreneurs; or engage in some sort of commercial practice. Sometimes when we (practitioners) are invited to talk about business or acquiring financial resources, we really struggle to find language and meaning about the relationship that each of us have with money. For some of us, conversations about money are activating, triggering, or even traumatic due to our familial or relational history of financial abuse, abandonment, or neglect. For others of us, we welcome the opportunity to have candid dialogue but we may not be sure about what to ask or disclose.

Given this deficit of our field, more spaces are needed for sexual, relational, and mental health professionals to share their business-related experiences so that our field could begin to have more formal discussions about financial negotiations, management, marketing, and planning. As a mental, relational, or sexual health professional, what business decisions have you had to make over the past five years?

Picture of James Wadley wearing a grey suit with a light shirt and peach-colored tie. He is looking directly at the camera and is smiling.

Dr. James Wadley (pictured here) is the Director of CFR’s Post Graduate Certificate Program in Sex Therapy.

About the Author

Dr. James Wadley, CST-S, is Director of the Sex Therapy Program at Council for Relationships. As a scholar-practitioner, he is a licensed professional counselor. He is the founding editor of the scholarly, interdisciplinary journal, the Journal of Black Sexuality and Relationships (University of Nebraska Press). He is also the founder and Principal of the Association of Black Sexologists and Clinicians. If you have questions about the business of sex therapy in 2023, email Dr. Wadley at jwadley@councilforrelationships.org.

Are you looking for a sex therapy appointment? See our Therapist & Psychiatrist Directory to find a CFR therapist or psychiatrist near you.

About CFR’s Post Graduate Certification Program in Sex Therapy

CFR hosts a unique program offering clinical, supervisory, and educational components for AASECT sex therapy certification. Clinical, supervisory, and educational components for sex therapy certification are typically offered onsite – but are currently online due to COVID-19. The curriculum is designed for post-graduate clinicians who want to expand their clinical repertoire in sexuality.

Click here to learn more about CFR’s Post Graduate Certification Program in Sex Therapy and to apply to join our next cohort to become a certified Sex Therapist.

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