Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003. The state of the art may have changed since the publication date. Gay men, sexual risk and therapy. Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003. Risk reduction must go beyond safe sex guidelines and encompass the ongoing process of sexual negotiation.
Therapists can play a role in assisting clients to safely navigate sexual activity.
Several case scenarios of therapy related to sexual risk, particularly among gay and bisexual men, are discussed. For the sexually compulsive client, sex often camouflages depression, hopelessness, anxiety, or rage. His therapist might negotiate a contract around sexual acting out, interpret and explore the specific meanings of acting out, and suggest the possibility of couples' counseling. The second case scenario involves an uninfected couple, Phil and Tom, who are exploring non-monogamy. The therapist can assist the couple in negotiating a relationship contract that requires the trust that partners will keep their agreements and disclose breaches in sexual behavior.