Chemsex is not systematically problematic – but when clients are struggling to manage the risks, balance their lives, or to give up a practice they no longer enjoy, all therapists need to know how to respond. In the second of two blog posts aimed at general practitioners, psychosexual and relationship therapist Silva Neves shares the most common difficulties reported by clients who engage in chemsex – and emphasises the role of sex-positivity, harm minimisation and cultural competency in supporting clients when they are struggling.