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But Brown is not a psychiatrist, a psychologist, a marriage family therapist, or even a clinical social worker. She holds no state license in any of the regulated mental health fields. Brown calls herself a sexologist, a profession the state does not recognize and therefore does not regulate. Brown also calls herself a doctor, based on the Ph.D. she holds in sexology from San Francisco's Institute for the Advanced Study of Human Sexuality, a school founded 30 years ago by a former Methodist minister who claims to have amassed the world's largest erotic art collection. The Institute offers doctorate degrees in erotology and sexology; these three-year programs include practicum courses and require a dissertation. Brown's 1979 doctoral paper was titled "Initiating Marital Coitus."
"It's just like a degree from Stanford or any other university, except that it's in sex," says Institute president Ted McIlvenna, who is also careful to say that his school -- which is not accredited by the American Psychological Association -- does not train people to practice psychotherapy. "A sexologist is an educator, someone who gives out information, not a psychotherapist. We say there needs to be full disclosure; that you put on the wall, 'I'm a sexologist,' and when someone comes to you with a problem, you're obligated to explain what it is you can and can't do."
For the most part, regulators don't take sexology seriously. " '-ology' means 'study of,' and sex is sex," says Tom O'Conner, director of the California Board of Psychology, which licenses mental health workers statewide. "You don't often hear the word 'sexology' used legitimately; it's more of a slang [term] than a professional term. Of course, legitimate psychologists can focus on sex therapy, and many do."
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Brown was certified by the American Board of Sexology, a respected group based in Washington, D.C. that includes many bona fide psychologists as members. A certification from ABS, however, denotes only that a reputable psychologist specializes in sex therapy and is up-to-date and well-versed in sexuality. ABS certification alone does not allow someone to act as a therapist.
"Certification from ABS is not enough," says Dr. Addison Somerville, a Sacramento psychologist and California State University professor who helped establish the ABS' requirements. "[Brown] can call herself a sexologist if she's completed the courses, but if she's going to practice therapy in California, she must be licensed."
Because there are sex educators and researchers who don't practice as therapists, but would still like to be certified in sexuality studies, ABS issues certificates without any proof of license. Besides, licensing requirements for therapists vary widely from state to state, says ABS executive director Bill Easterling. "But that doesn't relieve anyone with ABS certification from their responsibility of getting a license," he says.
Somerville worries that a shortage of traditional psychologists focusing on sex therapy could encourage a proliferation of unlicensed sexologists. Indeed, sexology is a growing field, as more people look for expert guidance in specialized areas such as gender dysphoria, which, until recently, was not well understood and rarely treated with a positive prognosis. (It was only in the early 1970s that the American Psychiatric Association officially removed homosexuality from its list of mental afflictions.) Somerville, who 25 years ago became one of the first mainstream sex therapists, and who then initiated the then-controversial Human Sexuality course at CSU-Sacramento, says there are still outdated mental health conventions when it comes to sex.
"I'm not confident that traditional psychology can yet meet the needs of people with sexual problems. The training is not focused enough on the importance of sexual issues," Somerville says. "A lot of psychologists don't want to admit that they really don't know about things like gender dysphoria, and unfortunately, some still have biases regarding sexual variances."
For Somerville, the solution is getting more psychologists to specialize in sex, which will reduce the demand for unlicensed sexologists, and, at least in theory, improve the quality and professionalism of sex counseling. But even state regulators admit that licensing cannot eliminate impropriety. Among licensed psychologists, in fact, the most frequent cause for disciplinary action is sexual misconduct. In the last five years, nearly 50 licenses were revoked in California for improper sexual behavior by professional mental health workers.
Jeff Thomas, special projects coordinator at the state Board of Psychology, said the state does not regulate sexology because it is a new field, and difficult to define; sexology could entail anything from teaching techniques for preventing premature ejaculation to educating someone about the process of coming out as gay.
"It's in a very gray area, like hypnotherapy," Thomas says. "The bottom line is you have to look at the definition of psychology, and if what someone does matches that, then they need to be licensed as such."
Choate argues that Mildred Brown used misleading titles -- Dr., certified sexologist, clinical therapist -- that gave her the appearance of being something she was not. "When she introduced herself to me as 'Dr. Brown,' it's not like I said, 'Let me see your diploma,' " Choate says. "I automatically assumed she was a real, licensed therapist."
Beyond the 58-year-old Brown's Ph.D. education in sexuality at the San Francisco Institute, her schooling is sketchy. Her résumé is a hodgepodge of universities she never graduated from; she lists sporadic introductory-level psychology and sociology courses she says she took at Montreal's McGill University in the early 1960s and San Jose State University in the mid-1970s. She did earn a Bachelor of Arts degree from UCLA in 1976 -- in French.