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Most clinical psychology students aren't trained to address clients' sexual issues, concludes new research published in Training and Education in Professional Psychology (Vol. 2, No. 3).

The study found that 70 percent of the 157 students surveyed had no course-length training on effective interventions for even the most basic of client sexual issues, such as medication side effects that decrease libido, sexually transmitted diseases, menopause and birth control, says study author Andrea Miller, PhD, of Markham Stouffville Hospital in Markham, Ontario, Canada, who conducted the study with Sandra Byers, PhD, at the University of New Brunswick, also in Ontario.

"These kinds of personal questions seem to come out in sessions because a person may not feel comfortable asking a friend or parent," Miller says.

If a clinical program does not offer training specific to sexual issues, students should speak up in general therapy or assessment classes, asking, for example, how anxiety and depression affect clients' sexual functioning, Miller recommends. During their graduate clinical hours or internships, students can also observe clinicians working with clients on sexual issues and ask their professors for relevant books and articles that could aid their training.

In addition, it's important that students address their own potential biases about sex, says Miller. Clinicians may not realize they convey discomfort with sexual topics through fidgeting or diminished eye contact. Students can observe whether their body language creates an unwelcoming environment for clients by, for example, videotaping a session and looking at their reactions.

A thorough clinician, says Miller, should be able to comfortably ask clients about potential sexual issues because some people may never broach the subject themselves for fear of embarrassment. As her research found, not all clients will bring up sex, but when asked, most clients will have something to say.

—J. Clark