We've all been there. The client presents with a pregnancy scare or a repeat occurrence of an STI - and it slowly dawns that she (or he) isn't using protection. Oh dear.

Despite the barrage of sexual health advice, the message still hasn't taken.

The Scales of Motivation

Why? We're increasingly realising it may not be ignorance, forgetfulness or irresponsibility that makes clients fail over safe sex. Psychologically, motivation's often more complex than that.

Imagine a double scale - like the scales of justice - with two bowls. In one bowl is the client's positive motivation to want to use protection, to suggest using it, to refuse sex without it.

Tipping The Scales

But weighing on the other side may be a whole heap of negatives when it comes to actually asking the protection question.

Low self-esteem - meaning the client doesn't even raise the issue. Ignorance of protection benefits - leaving the client with no good ways to argue for it. Insecurity - that their partner will object, their relationship suffer.

To tip the scales in favour of safe sex, these negatives need to be offset by positives - building up clients' self confidence, resourcing them with good arguments, supporting them to counter partner objections. So how?

Building Confidence

Bottom line, clients will fulfil prophecies made about them; tell them they're irresponsible and they'll act so. Conversely, point out they're acting positively and they'll do that more: "You're obviously a sensible person and..." "It's clear that you want to stay safe, so..."

Specifically, rather than focusing on failure, it's useful to identify and comment on specifics that the client already gets right "It's great you tried to insist on a condom last weekend, even if ..."

Remembering Good Reasons

A client who remembers the positive reasons for using protection will be far more motivated to argue for it, far more able to make their argument convincing. So review benefits "Protection's good - infections aren't always obvious." "You've already told me you're not ready to get pregnant yet.".

In particular, clients may be unaware that protected sex can be more pleasurable. So build that awareness "Safe sex means you can relax... have a good time." "Condoms.... help him last longer" "Ribbed condoms ... give her intense sensations."

Overcoming Objections

Clients often simply don't know what to say when negotiating with a partner. So encourage them to identify precisely what objections they meet, then to create phrases countering those objections "It's not that I don't trust you - I always use a condom." "I understand condoms turn you off - but safe sex turns me on!"

As to the classic partner cry, "If you loved me...", it will help to remind the client that even if it makes waves, insisting on protection is a loving act. (It may also help to point out that a partner who resists protection loves only their own satisfaction...)

Offering Approval

Finally, remember the power of positive reinforcement; if the client knows that their health professional will be pleased if they use protection, they'll often be more motivated to comply.

So ending the consultation with a positive "It'll be so great if you can......", "I'm sure you can do this..." can do wonders to empower the client not just to think about using protection but actually to do so!

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About the author

Susan Quilliam is a relationships psychologist specialising in sexuality and sexual health. She is an author of 19 books, the latest of which is 'The New Joy of Sex'. A regular broadcaster on television and radio, Susan has a weekly agony hour on LBC.

Article release date: 7th August 2009