Studying Sex: A Content Analysis of Sexuality Research in Counseling Psychology

Abstract

Using a sex positive framework, the authors conducted a 61-year (1954–2015) content analysis of sexuality research in the flagship counseling psychology journals, the Journal of Counseling Psychology and The Counseling Psychologist. Given counseling psychology’s core strengths- and multiculturalism-related values, this study aimed to uncover which human sexuality topics were published most, whether publications aligned with a sex positive, neutral, or negative discourse, what methodologies were used, and differences in how populations were investigated across race. Researchers used an integrative approach to content analysis and human coding (Neuendorf, 2011). Results highlighted that out of 188 articles meeting criteria, a slight majority (38.05%) focused on sexual orientation, identity, and minorities topics. Only 4.78% utilized a sex-positive perspective. Quantitative and conceptual pieces were most published, and publications disproportionately focused on primarily White populations. When people of color were included, the discourse was sex negative. Implications for research and practice are discussed.

Outside of a special issue on sex counseling (Jacobs & Whitley, 1975) in The Counseling Psychologist over four decades ago, sexuality research in counseling psychology (CP) has been scant. While counseling psychologists have made important contributions to lesbian, gay, bisexual, transgender, queer, intersex, asexual (LGBTQIA) research (Atkinson, Brady, & Casas, 1981; Rostosky, Riggle, Horne, & Miller, 2009; Shelton & Delgado-Romero, 2011), sexuality research has been otherwise limited in the field of CP. This mirrors psychology’s overall commitment to sex research. Via the search term “sex research” on Springer Link, with the content type set to “articles,” other fields, including medicine (166,944), biomedical sciences (82,859), life sciences (76,949), and social sciences (41,839), dedicate more measureable attention to sexology than psychology at large (40,399). Despite values that presuppose a natural alignment with sexuality research in general, and sex positive sexology specifically, there are gaps in the type of sexuality research counseling psychologists conduct and publish in The Counseling Psychologist and the Journal of Counseling Psychology. The published research also differs in methodology and discourses engaged, based on race.

This content analysis described sexuality research in CP and explored gaps in the extant literature. While the American Psychological Association’s (APA) Public Interest Directorate has focused on sexuality, as it relates to sexual orientation (APA, 2011), HIV and AIDS (APA, n.d.), prevention of sexual abuse/assault/trafficking (Taskforce on Trafficking of Women and Girls, 2014), and sexualization of girls (APA, 2010), these interest areas overwhelmingly contribute to sex negative, preventative sexual health discourses, which focus on disease prevention and risk aspects of sexuality (Arakawa, Flanders, Hatfield, & Heck, 2013; Lewis, 2004). There is no APA division dedicated to sex and psychology, yet counseling psychologists endorse values that could shift sexuality research towards more eudaemonic, or sex positive, discourses. For example, across race and ethnicity, people of color are more likely to be the subjects of preventative discourses than eudaemonic discourses (Lewis, 2004). One goal of this study was to determine whether this was also the case in CP journals, where our value of multiculturalism proposes to guide our research. Another goal sought to determine the methodologies and samples in CP’s sexuality research. The current analysis described the sexuality research published in the two flagship journals of counseling psychology, The Counseling Psychologist (TCP) and the Journal of Counseling Psychology (JCP) (Reimers & Stabb, 2015) through July 2015. As there has been no previous content analysis of all sexuality research in CP, there were no limits to the year-span of the search.

Defining Sexology Terms

Sexuality research, or sexology, encompasses terms such as sex, sexuality, and sexual health, often used interchangeably. The definitions of these terms have shifted over time, with little consensus among researchers. The World Health Organization (WHO) published the first international definition of sexual health the same year the aforementioned Major Contribution was published, making a national, if not global, statement about what sexual health was and was not (Edwards & Coleman, 2004). In addition to the right to accurate information about sex and sexual pleasure, three elements were at the WHO (1975) definition’s core: (1) a capacity to enjoy sexual and reproductive behavior in accordance with a social and personal ethic; (2) freedom from fear, shame, guilt, false beliefs, and other psychological factors inhibiting sexual response and relationships, and (3) freedom from organic disorders, diseases, and deficiencies that interfere with sexual and reproductive functions (p. 191). This sex positive definition of sexual health aligned well with the research published in the 1975 Major Contribution, and it resonates with what the CP field, by professional identity, proposes to endorse today.

WHO (2006) later advanced sexology definitions by delineating between sex, sexuality, and sexual health in sexuality research. Sex is distinguished from sexual behavior, as the birth assignment of male or female based on genital markers (WHO, 2006). Sexuality is characterized by its role as a central organizing construct for humans that reflects not only the attitudes, behaviors, and values aligned with one’s sex, gender, and sexual identities, but also by eroticism, pleasure, intimacy, reproduction, desire, and the like. Importantly, this definition of sexuality attends to who one is on a biopsychosocial level with respect to other intersecting social identities and contexts. This inclusive definition emphasizes one’s right to make choices regarding their bodies and their abstention from or involvement in intimate relationships and sexual behaviors. Thus, sexuality research encompasses both sex and sexual health. These defining, comprehensive terms made for appropriate search stems to guide this inquiry within counseling psychology journals.

Counseling Psychology Values and Sexuality Research

Counseling psychologists are distinguished and guided by their core values. For many counseling psychologists, it is difficult to view any social condition without attending to those aspects that comprise the core of their professional, and often personal, identity (Packard, 2009). Several of the values, including the focus on a) strengths, b) healthy development across the lifespan, c) respect for diversity, d) the influence of sociocultural context, e) considerations of the whole self, and f) social justice (Packard, 2009), can serve as a useful framework when examining human sexuality research (Author, Author, & Author, 2016a). As early as 1954, CP journals published sex research, but at what point did the values that represent the counseling psychologist identity begin to inform these studies? Inversely, despite early inquiry in the field, it is important to determine the extent and manner in which counseling psychologists studied sex at all. The two flagship journals, TCP and JCP, point to an initial space for literature review and analysis.

A CP values-based perspective of human sexuality research engenders one to consider the good, the positive, and the strengths associated with healthy sexuality. Sexual health and wellness, as it relates to one’s quality of life, are then key points of analysis. Importantly, this attention to eudaemonic sexual health is considered vital to counseling psychologists in addition to the prevailing discourses on prevention, not in lieu of them. Essentially, the values of CP encourage the amplification of balanced, holistic accounts of sexuality, not just the risk-related aspects. Further, CP values require an exploration of healthy sexual and gender development in nuanced ways. Since holism and development across the lifespan are important components, this means counseling psychologists’ publications should exemplify how sexual health can be promoted across the varying stages of a person’s life with respect to the biological, psychological, cultural, and social impact it may have for them and others. Holistic and multicultural foci attune counseling psychologists to the broad areas of eudaemonic sexual health such as sexuality, gender roles and expression, and relational functioning, especially for marginalized cultural groups. Counseling psychologists are uniquely positioned and equipped to address issues around sexual pleasure (Syme, Mona, & Cameron, 2013). CP’s strengths-based background may encourage a sex-positive framework; therefore it is imperative to uncover whether CP publications represent this framework.

Sex Positivity in Counseling Psychology Research

Sex positivity, as a theoretical framework, acknowledges pleasure, freedom, and diversity (Williams, Thomas, Prior, & Walters, 2015). The framework is comprised of eight dimensions of sex positivity: (1) “Positive” Refers to Strengths, Wellbeing, and Happiness; (2) Individual Sexuality is Unique and Multifaceted; (3) Positive Sexuality Embraces Multiple Ways of Knowing; (4) Positive Sexuality Reflects Professional Ethics; (5) Positive Sexuality Promotes Open, Honest Communication; (6) Positive Sexuality is Humanizing; (7) Positive Sexuality Encourages Peacemaking; (8) Positive Sexuality is Applicable across all Levels of Social Structure. This eudaemonic discourse emphasizes sexual pleasure and sexual functioning, as an important component of human life (Lewis, 2004). An explication of these dimensions follows, to clarify how this study determined which manuscripts aligned with sex positive or preventative discourses.

The first dimension of sex positivity elucidates a near perfect alignment with CP’s value of strengths. This dimension encourages empowerment of participants or clients, particularly those who are marginalized and sexually diverse, to see and use their strengths in the development and expression of their sexual identities (Williams, Thomas, Prior, & Walters, 2015). The second dimension normalizes the fluidity and unique experience/expression of sexuality among individuals, across the lifespan and across culture. This dimension calls for appreciation and respect of those differences, as all people across cultures, levels of wellness, and sexual praxis are seen as human and deemed valuable in a sex positive lens, on par with CP’s values of multiculturalism and inclusion. The third dimension reinforces that positive sexuality can be explored through many methodologies and research paradigms, to answer myriad questions related to sex. They borrow the term “theoretical polyamory” (Shannon & Willis, 2010) to encourage the use of various theories to inform sex research. Building on the prior dimension, the fourth dimension states that research, training, and practice around sex and sexuality is done ethically and comprehensively, with respect for diversity. The American Association of Sexuality Educators, Counselor, and Therapists ethics code (AASECT, 2014) that guides sex positive practitioners are to be met at the level of the highest aspiration to do good and benefit those with whom we work. The fifth dimension notes that sex positive scholarship promotes open communication as it relates to sexuality, including disclosures about STI status, preferences, desires, and behaviors. An emphasis on freedom of ideas and language in sexual communication intends to create a safe space for developing and maintaining a healthy sex life.

Connected to language, humanization is the crux of the sixth dimension, which promotes that all people are treated humanely, even when their behaviors may be “problematic, even atrocious” (p. 9). Even people who offend are still people first. Furthermore, it is important to avoid derogatory terminology and language when describing people who are marginalized by sexual identity or STI status. Sex positivity and social justice are inextricably linked. The seventh dimension suggests that peace making serves as the intention behind our interventions and scholarship, which includes a shift from “war” and “fight” paradigms aligned with preventative discourses to “bridge building,” understanding, and peaceful outreach (p. 9). Relatedly, the eighth dimension acknowledges that interpersonal, familial, community, and societal contexts are inextricably linked to sexuality and serve as important sites of inquiry and influence (Williams, Thomas, Prior, & Walters, 2015). With these established tenets of sex positivity available to inform sexuality research, the scope of sexuality studies in counseling psychology can now fill several gaps.

Studies of human sexuality run the gamut from LGBTQIA (lesbian, gay, bisexual, transgender, queer, intersex, asexual) concerns to sexual decision-making. Several disciplines conduct sex research, including sociology, gender studies, public health, nursing, and medicine. There is also a specific field dedicated to sex research: sexology. The field of CP, with its emphasis on strengths-based perspectives, prevention, and multiculturalism, is especially poised to conduct important research of human sexuality, a subject area that has been wrought with taboo and stigma. The purpose of this study is to determine the scope, methods, topics, and populations of sexuality research published in TCP and JCP. While counseling psychologists present their research in myriad journals, JCP and TCP best represent the values of CP, as flagship publications (Reimers & Stabb, 2015). The journals selected for this content analysis are known to reflect the prevailing “zeitgeist, values, beliefs, and perceptions” of CP (Reimers & Stabb, 2015, p. 802). This study answered the following research questions: (a) Which human sexuality topics were published most? (b) How many of these articles aligned with a sex positive, neutral, or negative discourse? (c) What methodologies were used in human sexuality studies?, and (d) Were there differences in how populations were investigated (methods or framework) across race/ethnicity?

Method

This content analysis examined the sexual health discourses, methodologies, topics, and participant demographics in sex research within CP literature from the inception of the journals until July 2015. The study employed human coding, where the first author conducted the initial search and coding in 2013. In 2015, the second author conducted a follow-up search of JCP and TCP. The research team performed a tertiary literature review, with each team member rechecking both journals. Search terms included sexual*, condom*, HIV, AIDS, and contraception, which resulted in 190 articles (JCP, n = 91; TCP, n = 99). These search term stems were selected based on the aforementioned WHO’s (2005) definitions of sex, sexual health, and sexuality, which mark sexuality (sexual*) as an encompassing, comprehensive term for sexology research topics. Terms such as condom, HIV, AIDS, and contraception were added through review of other search terms within the selected articles. Upon review, two articles (Stracuzzi, Mohr, & Fuertes, 2011; Zea, 2010) were excluded because they were duplicates of previously identified articles. The remaining 188 articles (JCP, n = 90; TCP, n = 98) were coded by sexual health discourses (sex positive [eudaemonic], neutral, or negative [preventative]), methodology (qualitative, quantitative, or conceptual), racial/ethnic makeup of the participants, and human sexuality topics. The first author made the final determination on categorization, after discussion among the group.

The analysis of these articles followed Neuendorf’s (2011) six recommendations for content analysis preparation: theoretical backing; a plan for the scope of investigation; review of past research and development of measures; defining the population of messages to be analyzed; immersion in the message pool; and decision to use human vs. computer assisted coding. This content analysis used a sex-positive theoretical framework (Williams, Thomas, Prior, & Walters, 2015), clearly articulated above. In the plan for this investigation’s scope, the researchers employed an integrative approach to content analysis that described the message content (sex research) and combined “message data with data about the message source” (Neuendorf, 2011; p. 278). For this study, the message data were related specifically to descriptions of the article topics, discourses employed, and demographics investigated. These data represented what the article intended to convey and about whom. The message sources were the flagship journals of CP, and the associated CP values were data about the message source, because they represent who we are or aspire to be through the content of our publications.

The first author’s comprehensive review of the sex research in counseling psychology journals resulted in a code book to guide the secondary and tertiary reviews, meeting criteria for Neuendorf’s (2011) third recommendation. Taking an availability-based approach, we addressed Neuendorf’s (2011) fourth and fifth recommendations by reviewing and including all sex research published in the flagship journals from their inception until the point of manuscript preparation in July 2015. Finally, the selection and use of human coding met criteria for recommendation six.

Whereas an article may have been assigned to multiple topics, they were trichotomously coded by discourse. The researchers initially coded article discourses as eudaemonic and preventative, following Lewis’ (2004) descriptions. We later expanded coding to positive, neutral, or negative, based on a description of those types of discourses outlined in the only other sex research content analysis conducted to date (Arakawa, Flanders, Hatfield, & Heck, 2013). The Arakawa, Flanders, and Heck (2013) article made the case that there is a spectrum from sex positive to sex negative, not a dichotomy. Their categorization highlighted that some articles about sexuality may encompass both or neither positions, as it relates to the purpose of their study and the results. Our findings concurred with their assessment of the literature and our coding process reflects this.

While preventative discourses typically aligned with the sex negative code, and eudaemonic discourses typically aligned with sex positive codes, there was some variation that required greater specificity in the coding process and inclusion of the neutral category. For example, an article about the sex therapy process could be sex negative, neutral, or positive: the history of sex therapy would be coded as neutral, whereas an article about using sex therapy to eliminate dysfunction would be sex negative.

Arakawa, Flanders, Hatfield, and Heck (2013) operationalized sex positive articles as those “focused on such topics as, but not limited to: positive attitudes toward sex, sexual desire, sexual fantasy, sexual excitement, sexual pleasure, sex and happiness, orgasm, sex and intimacy, sexual satisfaction, positive and/or healthy relationships” (p. 311). Sex-neutral articles included topics such as “identity formation, prevalence of various sexual identities, or sexual behavior, or comprehensive sex education” (p. 311–312). Sex-negative articles included those that used preventative discourses or emphasized disease or problem models. They included “mental health problems, sexual dysfunction associated with sex, the dangers of sex, sexual stigma or shame, risky sexual behaviors, STIs, HIV/AIDS, teen pregnancy, homophobia, sexual harassment, trafficking in women, forced prostitution, biphobia, transphobia, negative attitudes, and sexual violence/abuse” (p. 311). Eight original article topic codes were inductively developed for the research team to follow, by reviewing and grouping article topics by theme. After collapsing topics, based on lack of occurrence, recurrence, or similarity, six topic codes remained. The final categorization is detailed in Table 1.

Table 1.

Content Analysis Codebook

STI – Sexually transmitted infections and sexual risk	These articles include research on HIV, AIDS, and other STIs, as well as pregnancy prevention. Sexual behaviors identified as influencing the risk to contract these STIs or have an unwanted pregnancy, such as condom use are included.
SO – Sexual orientation, identity, and minorities	These articles include research on people who identify as LGBTQIA, as well as heterosexual identity development and issues associated with conversion counseling or attempts to change sexual orientation.
SA – Sexual abuse, objectification, or victimization	These articles include research on survivors of sexual abuse, incest, and sexual assault. They also include articles on sexual objectification, aggression, rape, and molestation, perceived or perpetuated.
SF – Sexual functioning, satisfaction, and pleasure	These articles include research on sexual functioning, including sexual dysfunction disorders found in the DSM, sexual satisfaction, and sexual pleasure. Reproduction related topics are also included.
SH – Sexual health communication, attitudes, and values	These articles include research on sexual communication among partners and attitudes and values people hold and/or share about sexuality.
SC – Sexual counseling, education, and therapy	These articles include research on sex counseling and therapeutic interventions for sexual issues, as well as sex education prevention interventions and outreach.
E – Eudaemonic Discourse	These articles include topics related to sexual pleasure, satisfaction, improving sexual functioning, and advocating for the sexual rights of LGBTQIA and other marginalized groups. They align with the elements of a sex-positive framework.
P – Preventative Discourse	These articles include topics that relate to prevention of sexual health risks, such as contracting an STI, treating an STI, preventing sexual victimization, and preventing unwanted pregnancy.
Qual – Qualitative Research	These articles include studies that employ qualitative methodologies, such as consensual qualitative research, grounded theory, and case studies.
Quan – Quantitative Research	These articles include studies that employ quantitative methodologies, such as quasi-experimental design, cross-sectional survey research, and scale development.
Mixed – Mixed Methods Research	These articles include studies that employ a combination of qualitative and quantitative methods.
Conc – Conceptual Research	These articles include literature reviews, commentary, and introductions to special issues.
APOC – All People of Color	These articles have samples made entirely of POC.
PPOC – Predominantly People of Color	These articles have samples made of more than 50% POC.
AW – All White	These articles have samples made entirely of White people.
PW – Predominantly White	These articles have samples made of more than 50% White people.
N/A – Not applicable	These articles do not have a sample, because they are conceptual or theoretical.

After organizing based on discourse and topic, we coded methodology (quantitative, qualitative, mixed methods, or conceptual). Articles were assigned to only one methodology. Conceptual articles, such as literature reviews, commentary, and introductions, were included following the Reimers and Stabbs’ (2015) content analysis example that determined the subject of inquiry, sexuality, was often discussed in theory as much as it was studied empirically.

All articles were reviewed to determine the racial/ethnic makeup of the samples in qualitative and quantitative studies. Articles were coded as all People of Color (APOC), predominantly People of Color (PPOC), predominantly White (PW), and all White (AW). Where more than half, but not all, of the sample were People of Color, articles received a PPOC code. Where more than half, but not all, of the sample were White, articles received a PW code. Conceptual articles received a not applicable (NA) code for this stage of assignment.

Results

Research Question I

The first research question asked: Which human sexuality topics were published most in the two main CP journals? One hundred and eighty-eight human sexuality research articles were found within the Journal of Counseling Psychology (JCP) and The Counseling Psychologist (TCP) between 1954 and July 2015. There were six main topic areas found, with the overwhelming majority of articles falling under sexual orientation, identity, and minorities (n = 78; 41%). Several TCP Major Contributions (1991, 1998, 2004, 2010) contributed to this number of publications. Some articles related to more than one category, so the total numbers equal more than 188 (See Table 2).

Table 2.

Human Sexuality Topics Published in JCP and TCP

Topics	Number	%
STI - Sexually transmitted infections and sexual risk	32	15.61
SO – Sexual orientation, identity, and minorities	78	38.05
SA – Sexual abuse, objectification, or victimization	51	24.88
SF – Sexual functioning, satisfaction, and pleasure	13	6.34
SH – Sexual health communication, attitudes, and values	7	3.41
SC – Sexual counseling, education, and therapy	24	11.71
Total	205

Articles about sexual abuse, objectification, or victimization (n = 51; 27.13%) and sexually transmitted infections and sexual risk (n = 32; 17.02%) made up the second and third most published. These topics were relatively highly published because of special issues on sexual objectification (Szymanski, Moffitt, & Carr, 2011) and HIV (Hoffman, 1991). Very few STI articles mentioned diseases outside of HIV/AIDS. The sexual risk research was limited in pregnancy prevention studies as well.

Research Question II

The second question statedasked, “How many of these articles aligned with a sex positive, neutral, or negative discourse?” Articles that aligned with the sex negative discourse made up a large majority at 70.21% (n = 132). These articles largely included topics about sexual minorities, followed by sexual functioning, sexual abuse and victimization, HIV, and sex counseling and therapy. Neutral articles, those including topics about sexual identity and sex education, represented 25% of the sample (n = 47). Articles contributing to sex positive discourses on sexual health were few (4.78%, n = 9) and reported on sexual health and sex counseling.

Research Question III

The third research question asked, “What methodologies were used in human sexuality studies?” Of empirical studies, quantitative methods represented the majority (n = 91; 48.40%). There were 77 (40.96%) conceptual articles, including commentary, introductions, and reactions, as well as literature reviews and intervention descriptions. Eighteen qualitative studies and two mixed methods studies were also found. The Journal of Counseling Psychology published the large majority of the quantitative articles (n = 78), while The Counseling Psychologist published the large majority of the conceptual articles (n = 76).

Research Question IV

The final question asked, “Were there differences in how populations were investigated (methods or framework) across race?” The four categories for organizing the racial and ethnic demographic data were all White (AW), predominantly White (PW), predominantly People of Color (PPOC), all People of Color (APOC; See Figure 1). Eighteen studies did not specify the racial or ethnic demographics of their samples. They were not included in the count, although it could be reasonably assumed that those samples were all White or predominantly White, based on the historical context in which the articles were published (1958–1987). Five conceptual articles were written specifically about People of Color, but as they did not include a sample, they were not included in the count.

Figure 1.

Demographics of Sex Research Studies. This bar graph illustrates the number of studies in the content analysis that included the outlined demographic categories.

A total of 94 articles had samples with explicitly stated racial demographics. One study had exactly 50% People of Color (POC) and White people. Studies with PPOC (n = 5; 5.31%) and APOC (n = 7; 7.45%) were nearly equal. There were also six AW participant studies (6.38%). Studies with PW participants were the most frequent (n = 75; 79.79%). PW studies were published over ten times more than any other subject group. The APOC studies focused on sex negative, preventative discourses exclusively, with topics such as sexual abuse, sexual objectification, HIV, and pregnancy prevention. Methodologies included two qualitative studies and five quantitative studies. Among the six AW studies, four aligned with sex negative discourses. Topics included sexual abuse and sexual identity. The remaining two articles were neutral, with topics related to sexual orientation. Methodologies represented across these six AW articles were an equal split of quantitative and qualitative.

Discussion

The results from this study demonstrate that out of all six main topics of sexuality research in counseling psychology, articles about sexual orientation, identity, and minorities make up the majority. This category contains 53% more articles than those in the next main category: sexual abuse, objectification, and victimization. Representative of the Society of Counseling Psychology’s (SCP) stated values of multiculturalism and inclusion, this focus on sexual minorities is one way that researchers in the field attempts appear to publish research congruent to said values. Despite a focus on studying sexual minority populations, few eudaemonic, sex positive studies have been published. Further, none of the articles focused on consensual non-monogamy, polyamory or kink (Author, Author, & Author, 2016a). Articles contributing to the sex negative, preventative discourses in sexual health make up the majority of the field’s foci, as sex positive articles represent less than five percent of research published in the flagship journals. Although prevention is also a value of the Society of Counseling Psychology, the enhancement and enrichment of sexual experiences has mental health benefits that require additional exploration (Bridges, Lease, & Ellison, 2004). The only other sexuality research content analysis found similar results. Although Arakawa and colleagues (2013) surveyed a sample of journals within sexology at large and medicine, sex positive articles represented just seven percent of the articles published in their sample. The type of journal was significant, in that sexology journals such as The Journal of Sex Research and Archives of Sexual Behavior published more sex positive research than the medical journals, The New England Journal of Medicine and Obstetrics and Gynecology. However, counseling psychology’s percentages aligned more with the medical journals than the sexology journals’ trends toward sex positivity.

This study also found that counseling psychologists largely rely on quantitative methods to empirically investigate human sexuality, or they conceptually synthesize, review and address other human sexuality research. As such an intimate and integral aspect of living, expanding methods of inquiry can contribute to sex positive discourses more vividly. Finally, there is a glaring difference in the number of studies sampling predominantly White (PW) people. Greater than ten times more articles with PW samples have been published, and this estimate is conservative given that some articles published prior to the millennium did not specify the race or ethnicity of their samples. None of the studies with APOC or PPOC samples were sex positive, thus we miss a chance to extend multiculturalism beyond merely including POC. Choosing sex positive investigative frameworks with racial minorities relocates the discursive trend toward risk to pleasure and strength in a humanizing manner: a social justice opportunity.

Implications for Research

Although seven percent of the articles reviewed for this content analysis contribute to eudaemonic, or sex positive, discourses, only one explicitly stated that they were guided by a sex positive framework (Syme, Mona, & Cameron, 2013). As counseling psychologists undertake sexuality research, sex positivity exemplifies a value-congruent match for guiding this inquiry. Since 1981, counseling psychologists who identify as sexual minorities and some LGBTQIA allies contributed the most to sexuality research published in the flagship journal with their important work (Atkinson, Brady, & Casas, 1981; Rostosky, Riggle, Horne, & Miller, 2009; Shelton & Delgado-Romero, 2011), much of it within the past decade. Still, there is more to be done as it relates to talking about sexual behavior, attitudes, and pleasure through a positive lens.

In the two flagship journals, counseling psychology researchers conceptualize and write about sex differently based on the identities of their samples. LGBTQIA people are receiving more attention in sex research in the past decade than they have in forty years. Yet, despite an increase in published research on one marginalized group, LGBTQIA samples, along with people of color, are overwhelmingly examined through risk and medical models (Tolaymat & Moradi, 2011; Wang & Heppner, 2011; Simoni, Martone, & Kerwin, 2002). Arguably, sexuality research in counseling psychology misses the mark when it comes to marginalized groups, and when the focus turns away from prevention, the literature becomes even more scant for people of color. If counseling psychologists are to embrace sex positivity, attention to diversity must underscore the research more broadly. The current oversight presents a challenge to the multicultural paradigm, in that it ignores pleasure and sexual functioning among marginalized groups (Lewis, 2004). Sexual stereotypes, myths, religious beliefs, and health concerns may limit the pleasure and subsequent sex-related mental health benefits of People of Color (Bowleg, 2004), and counseling psychology continues to perpetuate foreclosed discourses around positive sexuality among racial/ethnic minorities. Undertaking research that presents both sides of the sexual health coin for racial/ethnic minorities is an important future direction for counseling psychologists, using a variety of methodologies and a strengths-based focus, in addition to emphasized commitment to multiculturalism and social justice. Although the scope of this study did not investigate other social locations, people with disabilities are also minimally considered in sex research, and lower social class is presented as a demographic or risk-variable, rather than an identity to explore further.

Qualitative and mixed methods studies offer especially useful options for explicating many sexuality topics. Like most journals, counseling psychology journals have privileged quantitative methods. Sexuality literature reviews and conceptual works add considerably to the body of research, but extending on the recommendations of these articles through qualitative inquiry gives voice to the lived experiences of sexuality across, race, class, gender, ability, and the lifespan. It also provides an opportunity for participants to articulate the positive aspects of sex that remain under-investigated in counseling psychology journals. A qualitative approach can also help researchers uncover how cultural messages differ and influence sexuality within international populations as well. For example, in a qualitative study on heterosexual Black men of Caribbean descent (n = 11), participants identified pleasure as an important part of their definition of sexual health (Crowell, Delgado-Romero, Mosley, & Huynh, 2016). Future studies should explore sexual experiences of racial, gender, class, ability status, and other minorities through a sex positive lens, employing a wider range of research methods.

Implications for Practice

With the exception of the 1975 special issue, the TCP and JCP are especially lacking in research about sex counseling, therapy, and other interventions to enhance sex. Counseling psychologists have an opportunity to bolster sex positive sexuality research as scientist-practitioners in a way that medical journals have yet to (Arakawa et al., 2013). Sex positive research can inform sex therapy, and sex therapy requires the strengths-based, developmental perspective that counseling psychology programs integrate into their trainings. Current training deficits include the actual presence of human sexuality coursework (Author, Author, & Author, 2016b). Increasing production and publication of sexuality research in counseling psychology journals, then, also provides literature upon which programs can develop the courses that better prepare trainees to intervene on sexual issues. This challenge is further explored in this special issue (Author et al., 2016b).

Furthermore, at a baseline level, counseling psychologists need to be able to use a sex-positive framework when talking about sexuality with clients from initial assessment, including open-ended questions about how clients identify, the nature of their sex lives, as it relates to the presenting problem, sexual health promotion practices, such as condom use, and changes in desire, arousal, and ability to reach orgasm. To increase the comfort level of trainees and licensed practitioners when talking about sex, extensive treatment of human sexuality and sex therapy should be intentionally integrated into continuing education opportunities presented by SCP during convention, the Great Lakes Convention, and the National Multicultural Summit. An intersectional, multicultural perspective should inform both the science and practice. Additionally, developing internships and post-doctoral fellowships that focus on sex positive sex therapy may be a new direction for counseling psychology practitioners. The Society of Counseling can develop a Special Interest Group for members interested in furthering sexuality practice within the division.

Limitations and Future Research

The present study examined sexuality research in the two main counseling psychology journals in the U.S. It could be that counseling psychology sexologists publish their research in other journals that specifically focus on sexuality or ethnic minorities. However, the findings of the present study highlight the foci, samples, and methodologies that have received the greatest attention in the top CP journals while noting those that have been ignored. Errors in categorization were checked thrice through secondary and tertiary reviews by the co-authors and the research team; however, there may be remaining errors given the human coding process (Neuendorf, 2011).

Future research should utilize sex positive frameworks to explore and examine topics such as sexual pleasure, behavior, functioning, and attitudes among all groups. For example, exploring difference in the topics and framework of sex research across gender. Continuing to study sexual minorities, researchers should begin to include sexuality in other marginalized groups, including people of color, people with disabilities, and people from low socioeconomic status backgrounds. An intersectional approach would bolster the studies, rather than isolating specific aspects of one’s possible identities, and a eudaemonic perspective should inform these inquiries, rather than a preventative perspective. Counseling psychologists who study sexuality should collaborate to develop a sexual health course syllabus to implement sexuality research into the model program. Increasing mixed methods and qualitative research about these topics would improve the scientific basis for these trainings. Training programs, such as practica and internships, would benefit from more direct dialogues about human sexuality with trainees, using sexuality research as an evidence-based framework. Additionally, sex positive sexuality research, and training informed by this research, should attend to topics like kink and polyamory, as these areas continue to be excluded from the published research in our flagship journals.

Conclusion

Sexuality research encompasses a broad scope of empirical and conceptual literature. As a behavior that can indicate and improve psychological well-being, sex is a shared experience across race, class, gender, ability, and sexual orientation. The field of counseling psychology needs an intentional focus on sex positive sexuality research. The present study highlights the need for a eudaemonic discourse in the study of sexuality, specifically among racial and ethnic minorities, a population that has historically been the source for risk and deficit models. It is important to note that focusing on pleasure does not mean ignoring risk, but rather provides a context for which sexual behavior occurs. Furthermore, a sex-positive focus could be a way to minimize the stigma and promote humanity. Counseling psychologists are uniquely positioned to lead in sex-positive research with diverse samples, utilizing culture as a context for understanding sexual health and well-being.