Core competencies for BESTCO certified sex therapists

In 2015, the leadership of the Board of Examiners in Sex Therapy and Counselling of Ontario (BESTCO) struck a committee to establish the first set of core competencies for the field of sex therapy. The inter-disciplinary committee used a modified Delphi approach. The resulting document, introduced here, was ratified by the BESTCO membership in 2019. BESTCO members must be able to demonstrate competence in assessment and therapy in core clinical areas as a condition of certification. Eleven clinical topics were identified for assessment and therapy with general and key features for each topic. These clinical topics include not only the DSM disorders (e.g., arousal difficulties, orgasm difficulties) but also broader areas including Lack of Knowledge about Sexuality, Desire Discrepancies, and Sexual Sequelae of Sexual Assault, Abuse or Other Trauma. The General Key Features for assessment are organized into 7 domains: History of the Problem, Sexual History, Medical/Psychiatric, Psychological, Cultural, Relational and Quality of Sex. The General Key Features for Therapy are organized in terms of principles of Clinical Orientation, Clinical Formulation, Referral/Collaboration, Psychoeducation, Interventions and Therapy. The emphasis in this document is on allowing therapists of differing clinical perspectives to articulate principles of assessment and case conceptualization from within their own frames of reference. We affirm that this must be a fluid document, updated to reflect developments in language, assessment, conceptualization, and treatment as those factors shift.