What does a sex therapist do? She or he offers help with sexual concerns by educating, using talk therapy, offering homework exercises and resources for further exploration to either individuals or couples. This is an ongoing conversation between client and therapist; there is no personal touching in the office. While no state to my knowledge offers a license for this specifically, a sex therapist must have some sort of advanced degree, Master’s or Doctorate, and be licensed as a psychologist, counselor, or social worker. He or she has advanced training and is usually affiliated with at least one professional organization such as the American Association for Sex Educators, Counselors and Therapists or the Society for the Scientific Study of Sexuality.

 A sex worker, on the other hand, is someone who exchanges some sort of actual sex for money. They can call themself an escort, a body worker or fantasy provider such as a dominatrix. By extension, a sex worker can also work as a sexual entertainer like a strip tease artist, pole dancer, or erotic film actor. Except in certain areas of Nevada where prostitution has been voted in, exchanging sexual services for money is illegal in the United States.

A sexual surrogate partner is one who is trained in hands-on therapeutic methods for dealing with such problems as sexual inexperience, erection/orgasm concerns and body issues. (See http://www.psychologytoday.com/blog/sex-sociability/201109/sexual-surrog...) Their work with a client consists of education, breathing techniques, body awareness and may include sexual interactions. This profession is neither legal nor illegal and there is no licensing of it. However there is a professional credentialing organization, the International Professional Surrogates Association.

Sex therapy is about much more than genitals, but if a prospective new client making an appointment states the problem as one of function – inability to get an erection, for example, or painful intercourse, I always suggest consulting a physician first to rule out or identify any physical component. Then we can discuss what isn’t working and what the desired aim is while taking physical factors into account.

After the client and I together define the problem and the goal what I do as a sex therapist is to put into context what is going on, what he or she is feeling and desiring. Often, then, my first job is to educate. I explain what the range of normal behavior might be and we look at the reality of his or her expectations. For example, I am reminded of a man who came to see me only once wanting to learn to make his erections last longer, a common enough concern. On exploration of his history, however, I learned that intercourse for him was already lasting an average of 30 minutes or so, way beyond what is typical. In fact, his partner was complaining of getting sore and tired during intercourse. Nothing I or she said could divest him of his goal of wanting to achieve an erection that lasted an hour in use. He had heard an old blues number called “The Sixty Minute Man” and he was determined to beat that record! And, no, I don’t know whether he ever did.

Since sex never occurs in a vacuum I want to explore with whom and under what circumstances sex generally does occur for this person in my office and what about that is not ideal. Whether a person consults me alone or with a partner I want to know what’s going on in the relationship, the terminology in use, how his or her partner(s) see the circumstances and whether the people involved have the same view of the situation and share the same goal. While I know that many relationship counselors do not do sex therapy, in the majority of cases I don’t see how a sex therapist can not also do relationship counseling.

One of the most common issues brought to my office is desire discrepancy. That is a difference in how often and in what manner the couple express themselves sexually. If one person prefers sex at night, for example, and the other person in the couple insists on sex in the morning, a compromise of sex at mid day will not be satisfying to either party. The sad fact is that within a monogamous relationship there is no ideal genuinely mutual solution when each has strong preferences that differ. Helping a couple come to that realization and looking at what is possible may honestly be the best that can be achieved.

So while sex therapy can not “fix” many of the problems brought to the table, it often can open new possibilities for individual pleasure and help couples strengthen their connection through improved communications….not an insignificant accomplishment.

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