The HAT Model in sex therapy: An interview with Dr. Sara Nasserzadeh
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therapist.com teamLast updated: 06/13/2025
Sex and intimacy challenges are among the most vulnerable and complex topics for clients to bring to therapy. Each client arrives with their own expectations, informed by unique and intricate histories. Where one may seek the space to develop their own solutions, another might crave immediate guidance or require a different approach entirely.
For many therapists, this variation makes it difficult to know how to best show up in the room. What role do our clients need us to play? What kind of support will truly help them move forward?
Navigating these questions requires not just clinical expertise, but an awareness of the holistic nature of sexuality.
Dr. Sara Nasserzadeh, an internationally recognized psychosexual therapist, social psychologist, author, and speaker, has developed a framework to help clinicians meet this challenge with confidence and sensitivity.
Her Holistic Assessment and Therapies (HAT) Model identifies four roles therapists can adopt to aid clients: facilitator, authority, delegator, and demonstrator. Each role represents a different way clinicians can show up in the room as the figure their client needs.
Dr. Nasserzadeh has been helping individuals and couples heal from challenges related to relationships and intimacy for over 20 years and across more than 40 countries. She’s authored three books on relationships and sexuality, served as a cultural and relational advisor for the United Nations, and is both a Certified Sexuality Counselor and Approved Provider with the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) and a Registered Supervisor and Senior Accredited member of the College of Sex and Relationship Therapists in the UK (COSRT). She is an associate marriage and family therapist in California.
In this conversation with therapist.com, she expands on the power of the HAT Model, breaking down the four roles it encompasses and how they may look in practice.
therapist.com: Could you give a top-level explanation of what the Holistic Assessment and Therapies (HAT) Model is and the intent behind it?
Dr. Sara Nasserzadeh: The reason I came up with HAT was twofold: First, I wanted to offer a holistic model which was not just about biology, pathology, psychology, et cetera in silos but about the cross section of them all. Everything that comes with the client into our rooms affects their sexuality, including politics, social location, and beyond.
I wanted to talk about the holistic aspect of this. We are bringing in the biological, psychosocial, social, physiological, and even political levels—everything that comes with the person into our rooms.
I wanted people to know that the role we, as providers, assume for ourselves in any given moment in the room, dictates what goes on within the space. If you want to break it down, HAT is about the different “hats” we wear. These determine what rules of engagement we have in the room and ultimately determine the outcome.
therapist.com: Within the model, you identify four different roles. Could you touch on what those roles are?
Nasserzadeh: Yes. One of them is the role of facilitator. The others are authority, delegator, and demonstrator.
A facilitator is somebody who goes in without assuming expertise. The expertise is in being fully present and in facilitating the process. The content will then be generated collectively. As therapists in this role, we ask informed questions.
Many of us were trained to stay curious with our clients. For me, that is only the starting point. A lot of people who are very frustrated with the therapy or coaching process will say, “Well, the therapist puts it all on me to come up with all the answers. They put it on me to educate them.”
Curiosity can carry a hint of ignorance. Questions that are fueled by curiosity alone are not always the most informed. I suggest that colleagues foster a sense of genuine interest in the clients and the sphere, educate themselves as best as they can, and be fully present with the process. This can lead to more informed questions. It’s an active role. We cannot be passive and just hold space for people.
therapist.com: So, facilitation is about asking informed questions. The role is supporting them in their own understanding.
Nasserzadeh: Exactly.They come up with the content, but we facilitate the generation of the content and the process with our questions and with our state of being in the room.
The second role is authority. Authority is something that I don’t think some people feel comfortable with, but it’s quite useful in certain situations. This is when you tell your clients what needs to be done.
One of the specific scenarios where assuming authority in the room helps us is when we are discussing topics that we know might feel uncomfortable for clients, shameful for them, or which might create defensiveness. Especially when addressing sexual issues you face this a lot.
For example, I might tell a client who does not know their body well, “Before I see you next, I need for you to look at your genitals in a mirror or masturbate once.” I explain the scientific reason behind what I am asking them to do so it is expert recommended, and they know that this is in service of their progress.
In a way, with our authority we are lending them the power. We take away the shame and the blame, because “the expert said so.” It creates a space of safety.
The third role is delegator. As a delegator, you’re giving back the sense of agency and accountability to the client.
Sometimes you will see that people put up resistance. You say, “I really would like for you to put aside 10 minutes a day for your touch exercises.” And they don’t do it week after week. Or they use camouflages to divert the process, saying “Our cultural or religious beliefs don’t allow this.” And their progress is halted, or they are getting too dependent on your guidance, and you want to help them gain some confidence.
In the role of the delegator, I’d say, “Here’s what I would like to happen. How can you make it happen? What are the resources that you need? Who is there to support you?” So they, themselves, come up with an idea to achieve the goal to help their process.
Research shows that when you delegate, people have a stronger sense of accountability and success. You’ll be amazed by the creativity that people have! In this way, there’s accountability, and it’s more sustainable because they came up with the solution.
therapist.com: Looking at the four “hats,” that just leaves us with the demonstrator.
Nasserzadeh: The demonstrator is used when you have role-play or real play, or you are going to show the clients props in the room.
For example, psychosexual therapists might sometimes use props to show clients how the genitals look or function. Or sometimes I record my couples, with their permission, and then play it back to them so they can see how they interact. Or they act out a pre-written scenario to rehearse how things should be done.
therapist.com: Do you find that you tend to put on one hat more often in the course of working with a specific couple? Or are you wearing several in a single session?
Nasserzadeh: I suspect I use all four of them in any given session with the same person or with the same couple. Sometimes clients come in and they just want to get things off their chest. So you find yourself just facilitating a safe space for them to go deeper into their emotions, and you just hold whatever comes. But even within that, I usually end with demonstration or authority or delegation of some sort. Something tangible that they can actually take away and do. This will give them a sense of completion, accomplishment, and above all a sense of agency. They feel that “I can do something tangible to change the situation.”
Interestingly, I have found that being aware of these roles and embodying them as needed can also free providers from feeling stuck. I see this as the most important piece in our work: To help people who think they are hopeless, helpless, or powerless over their sex lives feel just an ounce of sense of agency. And I feel through these roles we can do that.
To learn more about Dr. Nasserzadeh, the HAT Model, and her other work, you can visit her website. Her most recent book, “Love by Design: 6 Ingredients to Build a Lifetime of Love” is available on Amazon and in stores. She is currently developing a sex-informed therapy course alongside therapist.com’s parent company PESI, which will be available online when complete.
If you’re struggling with issues related to sex or intimacy, help is available. Visit our directory to find a licensed mental health therapist near you.
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