Blurrier Lines: Inside the Unregulated World of Sex Therapy in Israel

The demand for sex therapy in Israel has never been greater, but with touch therapy and genital massages, the line between treatment and abuse keeps getting blurrier

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'The immense demand has flooded the market with untrained and inexperienced therapists.'Credit: Netalie Ron-Raz
Shirley Gal
Shirley Gal

Sex therapy is nothing new. There’s evidence of providing sexual advice and aphrodisiacs from the dawn of history, while sex guides were written from India to Rome. And still, it only became a real profession in the early 20th century. Currently there are thousands of sex therapists working in Israel, some certified and others using a mixture of methods they developed or imported from abroad.

“Because sexuality is a meeting point between many realms of knowledge, treatment will often happen in multidisciplinary centers, where they’ll try to diagnose the source of the problem and coordinate treatment from the worlds of medicine, psychology, social work and more, as needed,” says Dr. Mijal Luria, director of the sexual health clinic at Hadassah University Hospital, Mount Scopus and deputy director of the Israeli Society for Sexual Medicine.

'She brought us a fur vagina doll, told my boyfriend that she’d show him how to touch a woman and made circles around the clitoris'

“Statistics worldwide indicate that around 40 percent of women and 30 percent of men suffer from sexual dysfunction. People who come to us are dissatisfied with their sex life, have disabilities and chronic illnesses or take medications that affect their functioning. This includes women who had cancer who are looking to redesign their sexuality, and men who experience erectile dysfunction after being treated for diseases. These people have a lot of baggage, and treating them requires a thorough theoretical grounding, clinical experience and a code of ethics.”

When treatment is trauma

To call the sexual treatment field a wild west would be an understatement. Today in Israel, there is no law codifying what a sex therapist is, what sort of training they should have, their code of ethics and whether there is any oversight in their practice. The immense demand has flooded the market with untrained and inexperienced therapists, and the fact that the state sets no clear guidelines only exacerbates the problem.

Patients ask if I’m a couples’ counselor, and I answer that I’m a certified sex therapist, but they won’t understand the exact difference between the two. Credit: Lightcube / Shutterstock

In an attempt to impose some order on this chaos, the Israeli Society for Sex Therapy was founded in the late 1980s. It accepts professionals who have completed a graduate degree in a therapeutic discipline and have also studied sex therapy and finished a three-year internship. The organization is still not recognized as a certifying authority by the state.

“Today, anyone can define themselves as a sex therapist, whether they finished a standard track of two degrees and an internship, a two-day tantra course, an NLP course or even no course at all,” says Lee Reuveni Bar-David, a certified sex therapist and director of the sex therapy clinic at the Meir Medical Center. “There’s a reason that the market is flourishing, and that more and more people are getting into it who have a coincidental connection to therapy at best. Until the Health Ministry codifies it in law, we’ll continue to have a problem.”

The patients don’t always know to tell the difference. “Patients ask if I’m a couples’ counselor, and I answer that I’m a certified sex therapist, but they won’t understand the exact difference between the two. And the difference can be dramatic,” Bar-David notes. “Therapists who haven’t undergone training aren’t always aware of the consequences of what they do. What if things get out of hand, or if trauma suddenly surfaces during treatment? There’s a ticking time bomb here. Now that we have a new Health Minister who gets it, I hope his agenda includes the regulation of the psychotherapy field, and right after that – passing the Sex Therapists Law.”

When it comes to yoni massage, opinions vary even within the alternative community itself, especially regarding the efficacy of the practice and ethical questions.Credit: yurakrasil/Shutterstock.com

“We are exposed at the clinic to horrible things, from unethical sex therapist to sexual assaults,” says Dr. Ariel Cohen-Arkin, Chairman of the ISST and director of the Sexology School at Sheba Medical Center. “A patient arrived, a religiously observant woman, after being ‘treated’ by a self-appointed sex therapist, for a case of vaginismus – an involuntary contraction of the vaginal muscles that prevents sexual intercourse. That therapist told the woman to lie on the bed, took out a dildo, and shoved it forcefully into her body. For this woman, the cause of the vaginismus is a traumatic, invasive experience in her past, and what happened only made it worse.”

Does that mean that the field is rife with potential for sexual abuse?

'After a year with the therapist I realized that it had really gotten to the point of self-abuse'

“We see more than a few cases like that. The initial contract in the field of tantra, for instance, is supposed to hold that if contact happens between the therapist and the patient, it would only happen with the patient’s consent and only if the patient wants it. In practice, in many cases, the therapist will bring the patient into a state of relaxation and a daze, and will sometimes have sex with them. Then, ostensibly, there will be no direct resistance, and the therapist will say ‘there, you’ve managed to have sex, we’ve solved the problem.’ Obviously, this is sex by force. As this is sexual abuse within a therapeutic space, it sometimes takes people a long time to even realized that they’ve been abused, because they supposedly agreed to it, so there are fewer complaints.”

A network of charlatans

“Since puberty, sex wouldn’t stop hurting,” says Maya (not her real name). “Along with penetration came clitoral pain. I had recurring urinary tract infections, and my boyfriend, who was with me for years, wasn’t very understanding or considerate. So for a long time, I pretended. I went down on him just to shut him up. After four years of just trying to please him, I felt like I couldn’t do it anymore. When I stood naked in the shower and he came in, I’d hide. He asked what would make me feel good, and I didn’t know what to say, and I realized that we have to get help.

Michal Maayan Don, who now runs “sacred sexuality” workshops.Credit: Arieh Domonin

“We looked for therapists and saw that the internet is full of charlatans and therapists that you don’t quite know what their qualifications are. Eventually, we chose a certified therapist, and from the first meeting I noticed red flags. I tried to say that I don’t have a desire for sex, so she sent me off to watch porn. It was traumatic. All the videos were full of rape and genitals smashing against each other. Suddenly I stumbled on a video with two women who turned out to be sisters. I couldn’t get it out of my head. I told my therapist, and she burst out laughing. I felt like she was belittling my experience, and she just sent me to watch more.

“She brought us a fur vagina doll, told my boyfriend that she’d show him how to touch a woman and made circles around the clitoris. I didn’t understand why she wasn’t asking me. I’ve been there, and I told her, listen, it hurts me, and she waved it off and said ‘strange, I’ve never heard of clitoral pain.’ Every time she came with some new concept, like ‘you have vaginismus.’ Let’s say that’s the diagnosis; if no doctor recognizes it, who exactly is supposed to treat me? I’ve been to gynecologists who told me that I have no problem, and a gynecologist the therapist sent me to prescribed an anesthetic cream for sex. I went back to the therapist and asked, why not prescribe a date rape drug and be done with it.”

Today in Israel, there is no law codifying what a sex therapist is, what sort of training they should have, their code of ethics and whether there is any oversight in their practice

So what did you do?

“After a year with the therapist I realized that it had really gotten to the point of self-abuse. That this is another person who thinks I’m lying when I say I feel pain. Then I got a recommendation for an alternative therapist with no credentials, but she was the only one who believed me. She taught me that I have to study myself and learn what makes me feel good, without goals, without pressure to climax. Take a mirror, look and understand what feels good. I got the sense that the certified therapist has a playbook, and if you don’t fit the plays, then you’re messed up. On the other hand, the alternative one didn’t judge anything I said. So many people minimized what I go through, and suddenly she gave me confidence.”

It seems that if things really were that simple, the sex therapy field would have been regulated a long time ago. But the truth is complicated, and not everyone is suited for every form of therapy. Some will prefer talk therapy with a licensed professional; others prefer touch guidance or therapy.

'Until the Health Ministry codifies it in law, we’ll continue to have a problem'

“I’ve been to conventional sex therapy and to tantric therapy, and although the sex therapist did a wonderful job, I never felt comfortable enough to reveal to her how disgusted I am by my vagina,” says Michal Maayan Don, who now runs “sacred sexuality” workshops herself. “With the tantric therapist, I sat and looked at the vagina, and suddenly I managed to connect with this place in my body that was charged with so much shame, guilt, and fear. I was healed by it, whereas the conventional sex therapy only brought me so far.”

Their own ethical code

Shachar Berlowitz, an intimate communication guide who writes a blog for Haaretz’s Hebrew edition, agrees with the approach. “You can sit and talk for a year about the orgasm, or have two sessions and show someone how to achieve it. Working with the body is an accepted practice – movement therapy is a recognized degree, Chinese medicine treats the body and mind, surrogate therapy. And yet, sex therapy beyond sitting and talking is currently controversial,” he says. “I don’t think psychology holds the only truth or has such a mandate. Use of awareness-altering substances, for instance, which is one of the most popular fields today, was considered alternative and dubious up to a few years ago.”

Along with this complexity comes questions of ethics and oversight, which preoccupy Israel’s alternative therapist community, one that due to its significant use of touch-based practices is in a hazy spot to begin with.

Dr. Ariel Cohen-Arkin, Chairman of the ISST and director of the Sexology School at Sheba Medical CenterCredit: Constantine Grossman

“I’ve been in this field since the 1990s, when it was known only to cognoscenti,” says Sujay Shemesh, a veterinary doctor and conscious sexuality and relationships instructor. “As time went on, people got into the spiritual world and began to come to workshops and festivals, and in recent years it’s really entered the mainstream. Israel has an audience of hundreds of thousands of people who are in touch with the alternative world, and this mass interest has brought a lot of new instructors. Some are qualified, and some are opportunists who jumped on the bandwagon without undergoing training. This breeds distrust by the people, who don’t always know who to turn to. It creates a situation where alternative sexuality is like the wild west, and there is definitely space to call for regulation, standards, orderly training, an ethical code.”

This situation has led Shemesh and others to create ALMA, the association for the advancement of intimacy and conscious sexuality in Israel, which tries to serve as the equivalent of the ISST in the alternative community. “For 15 years, I tried in vain to create an ethical code. Instructors want their freedom, not to be told what they can and can’t do. So I decided to work the opposite way: Teach and train instructors, and among other things teach ethics, treating trauma, develop an ethical code for contact therapy.

"We set a standard for training, and addressed things that had never been regulated like secrecy, or agreements that specified what the session would include. We created a mechanism that arranges consent in advance and that does not rely upon rolling consent by the patient, and we also set a mandated consultation with a third party for guidance and oversight. This is a significant breakthrough, because until now anyone could say they’re doing yoni massage [an intra-vaginal massage] without having to account to anyone.”

And the instructors who want their freedom changed their minds and will accept the association’s guidelines?

Dr. Mijal Luria, director of the sexual health clinic at Hadassah University Hospital, Mount Scopus and deputy director of the Israeli Society for Sexual Medicine.Credit: Shahar Luria

“I hope so. It’s okay if there are instructors who don’t want to join, and then the customer will have a choice, whether they want to go to a therapist registered with the ISST, an instructor registered with ALMA or a therapist who does not belong to either of these.”

An indifferent Health Ministry

“On my birthday I asked my husband to take me to a couples’ massage workshop. I was sure we would go to some sterile spa, but he took me to Kessem Bamaga (‘The Magic of Touch’), which is an organic farm where they do tantric and yoni massage therapy too,” says Sivan (not her real name). “For two-and-a-half hours, We were naked, the therapist was clothed, we learned to massage each other, and it was amazing and very erotic. For weeks afterward, I still felt charged, and like my body was vibrating, like I had heightened sexual energy. And so I kept going alone for treatments that include yoni massage. I’m not spiritual at all, but these treatments filled me with energy. It’s not like a physiotherapist for the pelvic floor or like someone touching you during sex. It’s a massage like anywhere else in the body, which also covers the vagina area, places that aren’t usually touched.”

And you weren’t scared beforehand?

For weeks afterward, I still felt charged, and like my body was vibrating, like I had heightened sexual energy

“Before the meeting, I went over a written contract which included the usual things, like a health declaration, and it said that the spa also offers this treatment. It’s your choice and you say yes or no. It’s all clear and orderly, and I have the right to stop it at any time. In addition, we specified what we were doing at the start of every session, if there’s something I don’t want done I say so, and at the end of the treatment the therapist asks how it felt and if I’m alright. I’m describing a very positive experience, but I’m aware that yoni massage can cause trauma, because it’s super exposed, and part of a field with no oversight.”

When it comes to yoni massage, opinions vary even within the alternative community itself, especially regarding the efficacy of the practice and ethical questions. This is amplified by orders of magnitude when it concerns massages for trauma relief or to treat medical conditions like vaginismus.

“Yoni massage is a radical practice. It’s not done casually, but only after looking into all of the options,” Shemesh says. “Often, during the massage, intense sadness, crying, anger, released fears will surface, and the idea is to take the area from a detached region with no sensation, or one which causes pain, to a live and vibrant region. This is a hard idea to impart to those who think this is something sexy. The idea that there is a therapist there sitting and feeding off of this is mistaken.”

Don agrees. “People are suspicious of touch therapists, as if they’re touching for their own benefit and not that of the patient,” she says. “But we bring health to very painful places. We teach people to feel their boundaries, to express them. we don’t touch a person to make them feel good, but to remove blocks. It’s the understanding that just like how a masseuse touches the back and brings release with fingers and oil, the blocked consciousness, the trauma, is inside the body. It’s true that some therapists don’t know how to hold the trauma, and that’s what training is for.”

Dr. Sujay Shemesh, veterinarian and and conscious sexuality and relationship coach.Credit: Avshalom Meishiv

The overwhelming majority of conventional therapists, however, oppose the method. “Trauma is absolutely not healed by contact, that’s one of the worst mistakes,” says Mirit (not her real name), a senior sex therapist at the ISST. “The vast majority of sexual abuse is perpetrated by people with whom contact began with a smile and pleasant touch, whether it’s a family member, a date or a relationship that started well. Over time, they take advantage of their power and that same good feeling, which leads to terrible harm, with the catastrophe afflicting both body and soul.

“I don’t think the alternative therapists mean to cause harm,” she says, “but they lack a deep understanding of the mind’s processes, in which this touch may reenact and reawaken the trauma. People must understand that when they go to alternative therapy and undress, they are bearing not only their bodies but their souls as well, the most vulnerable and sensitive place. It has a simply devastating potential.”

Within the general chaos, those seeking a sex therapist will encounter one of four types: sex therapists who are ISST members; alternative therapists; psychologists and clinical social workers who have yet to complete the ISST’s lengthy certification process; and those who have declared themselves sex therapists, with unclear basis.

Meanwhile, people dealing with sexual dysfunction or pain, chronic illness or a recent serious surgery – find themselves at the mercy of an unregulated and unsupervised market that does not require disclosure of therapists’ qualifications, leaving them exposed to charlatans. The Health Ministry does not recognize the field as one that requires oversight, and judging by the response sent to Haaretz, has no desire to start doing so. Repeated attempts to obtain comment by Health Minister Nitzan Horowitz were unsuccessful.

The Health Ministry said in response: “The ministry is a systemic regulator and does not oversee every individual treatment or patient in the healthcare system, whether in general medicine or psychological and psychiatric treatments. Regulation does not mean oversight of every individual therapy. The ministry has no specific approach to this topic, nor are there designated training or designated professional development processes in this field.”

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