Sexology

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psych844

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Would someone simply do clinical Phd and focus on human sexuality in internship?

I'm taking a 3rd year Human Sexuality course at Uni and this is really sparking my interest!
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That would be something that I would look for at the postdoc level. One, I am not aware of internships that focus solely or even primarily on this. If they are out there, they are small in number. Two, internship is mainly looked at as rounding out and solidifying your background, and after is really seen as the main specialization time period as far as clinical work goes.
 
Of course Human Sexuality sparks your interest :smack: A 3rd year...in uni? I forgot...are you in graduate school now? If so, I would suggest thinking about internships serving adults and couples, and (hate to say it) but even geripsych...that is where you get most of the sexual issues (such as erectile dysfunction, menopause, and lack of sexual drive) that require medical and psychology attention. You could also think about sites that offer LGBT/gender identity didactics because those sites may have patients that you can treat with said conditions. Generally speaking, most folks fare well with sexuality and their functioning, and do not require psychology assistance, unless it is medical.

Couples counseling may be particularly interesting...but then, you have to deal with a couple deciding to stay together or break their relationship apart. It becomes quite 'interesting' for the treating clinician, who should not be caught in the middle but often lives there...right in the middle of those battles. :poke:

I agree though...looks like post-doc may be the year to specialize because most internship sites want you train you to be well rounded within their particular population served. And I haven't seen sexuality (functioning/disorders) as a focus of a 'population' while combing through internship sites. Again, hate to say...I've seen trauma as a component of sexual dysfuction, but that is an entirely different focus than what you suggested, OP. Good luck!:luck:
 
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psych844 said:
Would someone simply do clinical Phd and focus on human sexuality in internship?

I'm taking a 3rd year Human Sexuality course at Uni and this is really sparking my interest!
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That's one route. Post-doc is also a good time to hone your specialty. For example, the University of Minnesota has great training opportunities at the post-doc level (http://www.sexualhealth.umn.edu/).

Another option is to do a doctorate at a program where one or more faculty specialize in sexual behavior or sexual disorders. This is a good choice if you are interested in an academic career in the field. Regardless, don't sacrifice the overall quality of the training. There are some sketchy "institutes" of sexology that offer doctoral degrees, but you'll be much better off getting high-quality training in clinical psychology and gaining experience as you go.
 
Of course Human Sexuality sparks your interest
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lol. There is a pretty big difference between enjoying discussions on human sexuality in a class and considering it as a potential career.
 
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psych844 said:
lol. There is a pretty big difference between enjoying discussions on human sexuality in a class and considering it as a potential career.
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Yes...and it takes maturity. I have no problem whatsoever discussing sexual issues with my patients in a mature, productive way. However, in training, I've worked with people who (for their own reasons) were avoidant of the subject due to their own issues with sexuality. It is always a sensitive topic, but things like sexual addictions, porn addictions, sexual assault all need to be addressed delicately and without judgement. I'm specializing in trauma (hence open to all of the above) but one of the things that prepared me was my 10+ years as a volunteer rape crisis counselor. Add the clinical training in a doctoral program and you have a good combination of gentle, yet need-to-know approach. (Not that you'll have time to seek out volunteer sexual assault programs and join while you're in graduate school but...for those that want more exposure...this is a good option)

I'll tell you, patients really appreciate when their clinician is open to discuss where they need to be in any regards. I would feel badly for the individual who wants to discuss a sexual issue but feels their clinician-in-training can't handle it, which is an entirely separate issue.

I also forgot to add that sexual issues (promiscuity, paid sex, impotence) comes up in substance use training as well.

Heeeeyyyy...thinking of all. Maybe a VA would be a good consideration for internship. Substance recovery services, LGBT, gerispych, childhood trauma, military sexual trauma are all incorporated in many VA rotations nowadays. Just a thought...
 
You might want to broaden your search to include Gender Studies. I have sometimes seen Master's programs or doctoral tracks in Gender Studies, but when you read the description Human Sexuality is included.
 
I know that some AMCs have a sex clinic with joint duties between psychology and various medical specialties.

There is a need in general, which seems to sometimes be filled with quacks.

AFAIK, there is zero license potential for a gender studies program.
 
Health psychology in general seems a good route to go for this type of training. Its in demand and (unfortunately) you tend to have an easier time getting reimbursement for it when it is secondary to physical health problems. Oncology in particular has an increasingly recognized need for folks with this type of background, whether it may be due to adjustment to physical limitations (prostate cancer), distress due to changes in appearance (breast cancer, testicular cancer) or just side effects of chemo/radiation for any number of other cancers.

There aren't too many people who specialize in it in psychology departments, but there are certainly some. Many folks in populations where there is an unmet need may also be open to doing work in it (e.g. working with a health psychologist specializing in cancer survivorship and focusing on this area).
 
There aren't too many people who specialize in it in psychology departments,
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Yeah, I should talk more with my actual prof as she's really nice, but she promotes sexology as a good career in part because she says she's one of the few experts in Canada in this area (and there are only probably about 10 in total in Canada). She's pretty well known and has written some books.
 
Can any of you give insight how a psychologist with this type of treating could help a cancer patient, post-tbi? is it sort of like neuropsych where the help is less therapy but more making the person understand the research/body/and why they are the way they are?
 
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Actually the biggest demand I can think of from what I have seen is doing sexual functioning rehab and counseling with SCI. Big demand for people who can do this in the VA where they have SCI units. It's not just education, there is a lot of counseling and rehabilitation that can happen in such a position.

As others have intimated, I would go the health psychology route and give yourself some flexibility, but there are definitely ways to incorporate it into practice.
 
Ollie123 said:
Health psychology in general seems a good route to go for this type of training. Its in demand and (unfortunately) you tend to have an easier time getting reimbursement for it when it is secondary to physical health problems.
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There is a need for it in the (physical) rehab community, particularly in spinal cord injury (SCI). It also comes up with head injury, limb loss, burn, etc. Doing a health psych or rehab psych fellowship should offer some training options, and possibly before then…but it may be harder to find because of the specific nature of the work.

This topic can come up in passing during more general assessment work, but it really deserves/requires a well trained clinician who can work with a person/couple for an extended period of time because education about the topic is much different than actually being able to make progress with it.

*edit*

I should have refreshed the page, I see WiseNeuro touched on this already.
 
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Just to confirm. You guys are saying that if you are treating people with SCI who also have sexual issues (you are able to bill that under medicare) ? I guess in Canada then it be even better as our healthcare system is free.
 
psych844 said:
Just to confirm. You guys are saying that if you are treating people with SCI who also have sexual issues (you are able to bill that under medicare) ? I guess in Canada then it be even better as our healthcare system is free.
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I am not certain what you are saying here, because grammar.
 
WisNeuro said:
I am not certain what you are saying here, because grammar.
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If a psychologist has a private clinic, and they see patients who's sexual issues are primarily caused by their medical condition, is reimbursement much easier?

I can't make the question more specific as i'm from Canada and have no clue how your system works.
 
psych844 said:
If a psychologist has a private clinic, and they see patients who's sexual issues are primarily caused by their medical condition, is reimbursement much easier?

I can't make the question more specific as i'm from Canada and have no clue how your system works.
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I've heard that billing for services associated with medical diagnoses is more readily reimbursed (and results in fewer hassles) by various insurance carriers than billing associated with mental health diagnoses. However, like WisNeuro mentioned, those in PP can speak to this infinitely better than can I.
 
AcronymAllergy said:
I've heard that billing for services associated with medical diagnoses is more readily reimbursed (and results in fewer hassles) by various insurance carriers than billing associated with mental health diagnoses. However, like WisNeuro mentioned, those in PP can speak to this infinitely better than can I.
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If that is true, this would make for an awesome PP in Canada since we have universal healthcare.
 
I work in a private practice setting where we bill insurances and we have no problem getting reimbursed for patients with sexual issues. I just don't know how much of a market there is. In all of my years of practice I have actually only had one patient where that was the primary presenting problem. Ironically, I have been talking to him about the medical and physiological aspects and the psychiatrist told him that he needed to get his mother out of the bedroom, i.e., the psychological issues. Sounds a bit too Freudian for me although there is some truth to it.
 
Its probably very tough to do in a traditional PP setting if that is your goal. I know several folks doing that work, but they are all in large hospital settings (VAs or AMCs). Smalltown is right that its rarely going to be the presenting problem in a traditional PP, which is why you are more likely to see it in large medical centers where there is a built-in referral process. Just like smoking cessation, weight loss or any number of other things...psychologists aren't the first thing people think of when they look for treatment on these issues, but it doesn't mean they can't help. The need is absolutely there in medical settings - it actually seems to be a growing area (albeit the growth seems to be slow). Whether it is enough to sustain a practice on its own probably depends on where you are, how good you are, what setting you are in and how many hours you actually need.

I think any of our comments about billing should be taken with a grain of salt. I believe we're all US-based and referring to billing here. I don't know what implications exist in Canada. I imagine with universal healthcare it would actually matter much LESS there, assuming the system is generally more standardized and you don't have a million different insurers with each one setting their own rules. My basis for making that statement comes from what I'm hearing through the grapevine here about frequent billing issues and have about elsewhere. I have no idea the extent to which it even applies across the US, let alone in Canada.
 
For US-based practice…if there is a clear medical condition (e.g. spinal cord injury) that is causing sexual dysfunction, then it is easily billed using the medical diagnosis. As the provider you are doing education, coping, problem-solving, etc. Whether you bill that as an H&B Code (meh…crappy rates) or as traditional psychotherapy (slightly better rates), that depends on the split of the content covered, as each CPT code has a description as to when it should be used. If you are treating someone bc they have sexual dysfunction due to depression….it'd be a MH diagnosis and one of the psychotherapy 90832/90834/etc. codes.
 
psych844 said:
If a psychologist has a private clinic, and they see patients who's sexual issues are primarily caused by their medical condition, is reimbursement much easier?
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In the US, private insurance is pretty restrictive about covering treatment for sexual disorders. I agree with T4C - you could use a health and behavior code to get around the issue and would be justified in doing that if it is related to a medical condition.

I don't think they have this problem in Canada, so maybe stay there if you want to work in this field?
 
MamaPhD said:
In the US, private insurance is pretty restrictive about covering treatment for sexual disorders. I agree with T4C - you could use a health and behavior code to get around the issue and would be justified in doing that if it is related to a medical condition.

I don't think they have this problem in Canada, so maybe stay there if you want to work in this field?
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On a slight tangent, does Canada have unrestricted access to psychotherapy then? There are usually some types of limits. In our state's medicaid program there is a 26 session annual limit that can be exceeded with an appeal for more serious cases. It used to be the same for kids and they just changed it to no limit which is nice because occasionally with kids we would bump into that limit and it is hard to end treatment when a kid is still benefiting but they are no longer critical.
 
smalltownpsych said:
On a slight tangent, does Canada have unrestricted access to psychotherapy then? There are usually some types of limits. In our state's medicaid program there is a 26 session annual limit that can be exceeded with an appeal for more serious cases. It used to be the same for kids and they just changed it to no limit which is nice because occasionally with kids we would bump into that limit and it is hard to end treatment when a kid is still benefiting but they are no longer critical.
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There are no limits that I'm aware of, but of course psychotherapy is only free if you visit a psychiatrist or if you get referred to a hospital out-patient treatment program (where there is usually a combo of psychiatrist/psychologists offering treatment). Psychologists (not in health settings) aren't covered under the health act, so you have to have insurance or pay cash/visa. From what I've heard, the insurance plans for psych are not that great.
 
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