Addiction A-Z

Sex therapy

When it comes to the term “psychotherapy”, most people probably picture sitting with a psychologist, psychiatrist, or other type of therapist, talking about difficult emotions or painful issues such as depression, anxiety, low self-esteem, or past trauma. What probably doesn’t come to mind, for the vast majority at least, is talking to a therapist – with their spouse or partner – about deeply personal sexual problems.

Sex therapy, or psychosexual therapy as it’s called in some parts of the world, is a specialized form of psychotherapy.  Like most other types of psychotherapy, sex therapy involves a significant amount of talking.  But, when it comes to resolving sexual problems, just talking about them – even with a licensed mental health professional – usually isn’t sufficient.  In fact, a lot of couples and individuals who end up seeing a sex therapist have already spent at least some time, often a fair amount, in regular couples or individual therapy.

While regular psychotherapy can be very effective in treating a wide range of emotional and psychological issues, it usually falls short when it comes to effectively dealing with sexual problems and disorders.  This is because sexual problems have a significant physical component, even if the root of the problem is primarily psychological in nature (i.e. there isn’t a physiological element causing or contributing to the problem).

Sex therapists are specially trained to deal with these types of challenges.  In addition to their regular mental health training and licensure (which may have included a course or two in human sexuality), they have in-depth training in human sexuality, intimacy problems, and related issues. Most sex therapists also work with physicians to ensure that any underlying medical issues have been ruled out or addressed when present.

Sex therapy, although an uncomfortable and awkward topic for many, can be very beneficial for adults who are unsatisfied with their sex life, struggle with sexual intimacy issues, or concerned that they may have a sexual disorder.  It can also be very helpful for couples and individuals who have a physical health issue (e.g. a disability or illness) that is negatively impacting their sex life.

It’s important to note that sex therapy can be effective for all adults regardless of age (i.e. young adult to elderly), gender, and sexual orientation.  Sex therapy also isn’t just for those who have a current sexual partner.   For example, many people seek out a sex therapist to address sexual issues that came up in a prior relationship or to talk about sexual concerns or intimacy issues that have made them reluctant to have a sexual relationship with anyone.

A fairly common misperception regarding sex therapy is that therapists have physical or sexual contact with their clients.  Sex therapists who are licensed mental health professionals aren’t sexual surrogates, and they don’t engage in any type of sexual or physical activity with their clients – either in therapy sessions or outside of sessions.

Problems and Concerns that Can Benefit from Sex Therapy

Sex therapy is appropriate for a wide range of problems related to sex and intimacy.  These problems may be acute or chronic, mild to severe, and relatively straightforward or quite complex.  Problems that sex therapists treat include:

  • Low libido
  • Loss of interest in sex
  • Incompatible sex drives (e.g. one partner wants sex every day, the other is happy with a few times a month)
  • Erectile dysfunction
  • Premature ejaculation
  • Sexual compulsions
  • Difficulties having an orgasm (anorgasmia)
  • Painful intercourse (dyspareunia)
  • Issues related to past sexual abuse or trauma
  • Physical or health issues that are negatively impacting sexual performance, desire, or function
  • Body image issues that are impacting intimacy
  • Concerns related to sexual orientation
  • Conflicts regarding sexual activity (e.g. one partner wants to experiment or engage in sexual activities (e.g. bondage) and the other is doesn’t)
  • Lackluster sex life / boredom in the bedroom
  • Difficulties with trust and sexual intimacy after a partner’s infidelity
  • Sex during pregnancy and shortly after childbirth
  • Anxiety about having sex for the first time, with a new partner, or when it’s been a long time since the last partner
  • Sexual issues and concerns related to menopause
  • Difficulties talking about sex with one’s partner

The Sex Therapist’s Perspective / Alleviating Common Concerns

Most people have a difficult time revealing – let alone actually talking about – sexual problems and concerns.   The idea of discussing them with a therapist, no matter how experienced and qualified he or she may be, can be absolutely terrifying.  The fear of being judged, ridiculed, or shamed often runs very deep, especially for those who worry that their sexual thoughts, feelings, desires, or concerns are abnormal, “freakish”, or an indicator of an even bigger or more ominous problem.  What a lot of people don’t realize is that many sexual problems are fairly common.  But since most people don’t share those issues with anyone, sometimes even their spouse or closest friend, the tendency is to think that they’re the only ones (or one of very few people) who are experiencing it.  Unfortunately, this perception often gets in the way of seeking the very help they need.   (If this sounds like you, this section is especially pertinent!)

Understanding things from a sex therapist’s viewpoint may be helpful in alleviating some of your concerns, especially if you think you would benefit from sex therapy but are very hesitant to pursue it.

First, sex therapists, like other therapists, fully understand that opening up – especially to a complete stranger – about deeply personal matters, and especially matters that elicit feelings of shame and embarrassment – is difficult, awkward, and uncomfortable for a lot of people (and with sexual issues, probably the vast majority of people).  They get it; and they’re trained to put you at ease.  It’s not their job to judge you.  It’s their job to listen carefully and help you work through whatever it is that is bothering you – no matter how weird, bizarre, or taboo it may seem to you.

Second, sex therapists accept you for who you are.  It doesn’t matter to them if you’re gay, lesbian, straight, bisexual, bi-curious, transgender, or completely confused about your sexual orientation.  It’s not their job to judge you or change who you are. They’re not going to look down on you or criticize you if you’re a sexually inexperienced 60-year-old. It’s their job to help you with your current sexual concerns.

Third, chances are they’ve heard “it” before.  That’s not to diminish the importance of your concern. Rather, it’s to ease the fear that you’re going to be the client who shocks the sex therapist (therapists, as a general rule, are pretty hard to shock) or whose problem is so unusual or so bizarre that the therapist will have no idea how to treat it (extremely unlikely).

Fourth, even though opening up may feel awkward and unpleasant at first, a skilled sex therapist will help you identify and explore the issues at hand.  This will help you have a better understanding of your own sexual needs, and also enable you to express them more clearly with your current or future partner.

Finally, sex therapists recognize and understand that sexual issues aren’t necessarily a “side effect” of unresolved relationship issues.  They know better than to assume that if you and your partner just work on your relationship all the sexual problems will magically subside and your sex life will be nothing but bliss from that point forward.  If that were the case, couple’s therapy would have been sufficient.

How Sex Therapy Works

As with other types of psychotherapy, when you first begin sex therapy you’ll likely be asked to describe your particular sexual problem or concern – the issue that led you to seek help in the first place.  In order to help you, the therapist needs to have a clear understanding of what you hope to accomplish in therapy.  Once the root of the problem is identified, your therapist will discuss the best course of treatment.  In some cases, the root of the problem is easily identified.  In others, however, it may take some time to unearth the underlying issue or cause, particularly if it’s a complex or multifaceted problem.

Some people may find it difficult to articulate what they’re feeling or experiencing, especially first starting out in therapy.  When this occurs, the therapist will help by asking appropriate questions and clarifying responses as needed.  Even though the topic may be uncomfortable or awkward for you (and sex therapists fully understand this), it’s not uncomfortable or awkward for them.  Most people quickly become more relaxed and open once they see that the therapist is relaxed, knowledgeable, and understanding.

Although the course of therapy will vary based on a variety of factors, the early sessions are usually focused on information gathering and exploration.  As a client, you (or you and your partner) will be encouraged to consider and explore the thoughts, feelings, behaviors, past experiences, and any other things (e.g. cultural or religious factors) that may be contributing to the problem.  It’s not uncommon for current sexual feelings and attitudes to be influenced – often unconsciously – by traumatic or significant events in a person’s past, such as sexual abuse, earlier sexual experiences that were unpleasant or negative, or a damaged body image (e.g. due to childhood bullying or a history of being overweight).

If you and your partner are in therapy together, your therapist will also likely ask about your history as a couple and the current health of your relationship (e.g. are there serious or chronic conflicts in the relationship that may be causing or contributing to the presenting problem).  Even if the problem is primarily physiological in nature (e.g. painful intercourse due to vaginal dryness, which is leading to much less frequent sex), it’s important to discuss the impact the problem is having on you personally, as well as on the relationship.

It’s not uncommon, in sex therapy as well as other types of psychotherapy, for the underlying or “real” problem to be quite different than the “presenting” problem.  For example, a couple may be having conflict due to one partner’s low libido or loss of interest in sex.  While there are numerous things that can impact libido and desire, such as medication, illness, stress, aging, or depression, the loss of interest (and alleged low libido) may really be due, for example, to resentment and conflict within the relationship itself.  A skilled sex therapist can help couples address the conflict and communication problems that are hindering their sex life and eroding their ability to be genuinely intimate with each other.

Methods and Techniques Used in Sex Therapy

Resolving the issues that led you to sex therapy will often involve a variety of things.  These may include:

Working on improving communication skills – It’s not uncommon for poor communication to play a significant role in sexual problems, particularly with couples.  During times of conflict or stress, communication often begins to break down.  This tends to have a negative impact on their sex life as well.  Also, when sexual problems appear, if communication wasn’t good to begin with, talking about the problem with each other – at least in a way that’s beneficial – will be even more difficult.  Improving communication is also very important for those who have a difficult time being assertive in the bedroom.  Many people resign themselves to an unsatisfactory sex life because they’re unable to express their sexual desires and needs to their partners.  Communication exercises can help both you and your partner resolve conflict more quickly and effectively, and also make sex more fun and satisfying

Learning and practicing mindfulness techniques – Mindfulness is an important part of a healthy and satisfying sex life.  Some people approach sex as if it’s a race to the finish. Others go through the motions to accommodate their partner while thinking about other things (e.g. the long list of things they need to get done that week).  Mindfulness involves being fully present in the moment, and focused on what you’re experiencing during sex.  Being more mindful will make you much more attuned to what your partner is experiencing as well.  Mindfulness can take sex to a whole new level.

Education – Sex therapists are especially knowledgeable about human sexuality.  Your therapist will educate you and help you understand the various factors and / or underlying causes of the problem(s) you’re experiencing.  For example, erectile dysfunction may be caused by several different factors. Understanding what it is and why it may be occurring can help remove the stigma and shame that often accompanies it.  As part of education, your therapist may have you and your partner watch educational videos or read materials to learn ways to improve your sex life or sexual functioning.  Examples include new sexual techniques or exercises to help strengthen certain muscles.

Exercises and techniques to practice at home – Sex therapy often involves teaching couples (and individuals) sexual or intimacy-enhancing exercises and techniques that can be practiced in the privacy of their home.  For example, sensual massage or “sensate focus” is often used to help couples with sexual problems.  This exercise, which focuses on caressing and massaging each other, doesn’t involve any sexual contact or activity. It enhances intimacy by helping both partners feel more comfortable and safe with each other as they learn to give and receive pleasure.  This can be especially helpful for couples in which one partner has a history of sexual trauma (e.g. rape survivors or individuals who were sexually abused as children), couples working on rebuilding trust after infidelity, and couples who are unable to engage in sexual intercourse and want to learn new ways to pleasure each other sensually.

Other exercises used in sex therapy may include genital stimulation exercises, exercises that include taking turns focusing solely on one partner’s sexual pleasure (e.g. to help understand what works for your partner, to learn to be more giving sexually, or to help a partner who has difficulty reaching orgasm or who has erectile problems), and trust-building exercises.

It’s important to note that these types of exercises often elicit intense emotions as well as bring deeper issues to light.  When this occurs, sex therapy sessions are used to explore and address these issues.  This can be a very positive thing as it helps individuals and couples become more self-aware and also gain a deeper understanding of their partner.

Other Considerations in Sex Therapy

Length of Therapy – Sex therapist isn’t designed to follow a specific treatment protocol spread out over XX number of therapy sessions.  The length of time required to resolve a sexual problem will vary depending on a variety of factors.  These include the complexity of the issue and whether or not other or deeper issues arise that may take additional time to fully address and resolve.

Common sexual problems are often resolved within a few months of sex therapy.  However, it’s not at all unusual for sex therapy to last for a year or more.  Although some people think therapists intentionally keep their clients “sick” or stuck in order to keep them in treatment (for financial reasons), any ethical therapist’s goal is to get to the root of the problem as quickly as possible and provide you with the most effective and efficient form of treatment to resolve it satisfactorily. However, therapy is always a two-way street. If you ignore your therapist’s suggestions and recommendations, things aren’t likely to improve.

The Benefits of Working as a Couple – Another important thing to consider with sex therapy is this:  if you’re in a relationship and the sexual problem is impacting both of you (which is almost always the case), sex therapy will generally be more effective if you do it together as couple rather than only one of you coming to treatment.  Granted, if your partner is unwilling to come to therapy then you can’t force him or her to do so (and that’s usually an indicator of an even bigger relationship problem).  Sex therapy can still be helpful in that situation, but ideally, it will involve both of you working together.  Even an “individual” problem (e.g. a history of sexual abuse or impotency) has a better chance of resolving with your partner’s support and understanding.

Involving Other Treatment Providers – In many cases, sex therapy is sufficient to resolve the problem that led you to therapy.  However, there are many times in which there’s a known or suspected medical / physical issue that’s causing or contributing to the problem.  Your sex therapist will refer you to a physician or other healthcare professional (e.g. a physical therapist) to assess and treat that aspect of the problem.  If you (or your partner) have a mental health disorder that isn’t being treated and is contributing to the problem, your sex therapist may refer you to a psychologist or other mental health professional for treatment specific to that issue.  This enables the sex therapist to focus on treating the sexual problem.

When other treatment providers are involved, you’ll typically be asked to sign a release for those whose treatment is relevant to your sexual problem (e.g., your dentist probably won’t need to sign a release but your gynecologist or primary physician likely will be).  This not only ensures that everyone is on the same page; it also gives your providers permission to share information as needed and work together to ensure that your treatment is comprehensive and effective.

What to Expect

In many ways, sex therapy is very similar to other forms of psychotherapy.  You’ll meet with your therapist in his or her office, usually on a weekly basis with sessions lasting about an hour.  You’ll talk about your concerns, share pertinent history, discuss treatment options, and then pursue a mutually agreed upon course of treatment.

As mentioned previously, sex therapy doesn’t involve any sexual contact or activity during sessions.  Any sexual activities or exercises recommended by the therapist will be done (alone or with your partner) in the privacy of your own home in between sessions. Your therapist will usually use at least part of the next session to discuss how the exercise went, any emotions it evoked, what it was like for you and your partner, any discoveries you made as a result, and so on.

As therapy progresses, the course of treatment may be adjusted as needed (e.g. to address new or underlying issues that may come up).

Preparing for Therapy

Before starting sex therapy it can be helpful to write down, in advance, any information that may be helpful to the therapist.  This may include:

  • Any physical, medical, or mental health issues or conditions that you have and any treatment you’re currently receiving
  • Any medications you’re taking (many medications have sexual side effects)
  • Any supplements (including herbs, vitamins, and other supplements) you’re taking
  • Any current or recent stressors (e.g. a major loss or trauma, or a significant change or transition in your life such as starting a new career, recent childbirth, divorce, retirement, or moving to a new city)
  • Specific details of your sexual problem, including frequency, how long it’s been going on, previous treatment you’ve had in an effort t to resolve it (e.g. medical evaluation, medication, couples therapy, etc.) and anything else that might be relevant
  • Any questions and concerns you want to be sure to discuss with your therapist

Although this isn’t a necessary step, it can be helpful to have things written down in advance – especially if you’re prone to “drawing a blank” when you’re nervous or feeling overwhelmed.  Many therapists use the first one or two sessions for history and information gathering, which usually includes questions pertaining to most of the above.  He or she may also have a questionnaire or intake form for you to fill out at the beginning of treatment that covers similar topics.

Before Pursuing Sex Therapy

It’s not always easy to determine if sex therapy is appropriate for the sexual specific concern or challenge you’re facing.  Before entering into sex therapy, take some time to consider and explore other options. You may find that you don’t really need sex therapy after all.

Take some time to educate yourself.  Even though there’s a plethora of information about sexual health and intimacy-related topics readily available today, many people have a pretty limited understanding when it comes to this topic.  A bit of information (from reliable sources) can go a long way towards helping you determine if you need sex therapy, regular therapy, medical attention, a self-help DVD or book, or merely a new way of looking at things.  Some people have unrealistic sexual expectations, while others entertain common misperceptions that cause unnecessary distress and frustration.  You don’t have to become an expert.  But taking some time to read, watch, and learn will help you make an informed decision with regards to the best course of action.

Talk to your primary care doctor, gynecologist, or other specialist about your concerns.  For example, if hormonal issues are wreaking havoc with your sex life, certain medications, supplements, hormonal treatments, and / or lifestyle adjustments may be sufficient to resolve the issue.  If you suspect a medical problem, your primary physician or gynecologist can do an assessment and / or refer you to the appropriate specialist (e.g. a urologist).

Rule out the impact of substances.  It’s important to remember that alcohol or recreational drugs, prescription or OTC medications, and even smoking can have a negative impact on both sex drive and functioning.  Educating yourself about and addressing these issues first may help you make appropriate changes so that sex therapy isn’t necessary.  Be sure to talk to your doctor before starting, changing, adjusting, or discontinuing any medications.

Finding a Qualified Sex Therapist

If you’ve determined that sex therapy is the option to pursue, then it’s important to find a therapist with the appropriate experience and qualifications.  Your primary care doctor (or other treatment provider), EAP, or health insurance company may be able to refer you to a sex therapist in your area.  Depending on where you live, there may also be a sex therapy clinic that you can contact and set up an appointment.

You can also contact the American Association of Sexuality Educators, Counselors, and Therapists (AASECT).  The association provides a “locate a professional” search option on its website.

It’s important to find someone who has the appropriate training, licensure, and other credentials (such as certification by the AASECT) to provide sex therapy.  Don’t be hesitant to ask prospective treatment providers about their background, credentials, and experience.  You should also find out what the therapist’s fees are, and whether or not treatment is covered in your insurance plan.  Additionally, it’s important to find a therapist with whom you can feel comfortable.  If there’s no rapport after the first couple of sessions, it may be that the person you’re working with isn’t a good fit for you.

Sex is an important part of the human experience.  A healthy and satisfying sex life not only makes life much more enjoyable; it also has a very positive impact on both your mental and physical health.  Most sexual problems can be resolved with the proper approach, which may include sex therapy or other types of treatment.  Don’t let shame, fear, or embarrassment get in the way of seeking the help you need.  At the very least, you can set up a consultation with a sex therapist to ask about his or her services and get a feel for the person. Sometimes taking that first step is all it takes to get you on the path to a happier and healthier life.

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