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Should We See a Sex Therapist?

Putting to bed common fears about sex therapy and seeing a sex therapist

iStock - Deklofenak; used with permission; Sex Therapy
Source: iStock - Deklofenak; used with permission; Sex Therapy

Fears about sex therapy: the sex therapist will suggest a threesome to spice up our sex life, I’ll have to reveal all my past sexual escapades to my spouse, I’ll be shamed for how little I know about sex, or the sex therapist will be some New Age-Barbara Streisand-in-Meet the Fockers-flowy-flowery, weirdo.

Actually, “I can’t believe how long we waited to get help!” is the most frequent comment I hear from sex therapy graduates. Second only to the comments about my consulting room (“Oh, it looks just like a living room”). Third to the comment, “I didn’t know these feelings were normal.” I think people are afraid that a sex therapy room is a cross between a gynecological exam room and the Red room. Actually, there are no exams, no nudity and certainly no sexual touching. Sex therapy is a branch of traditional psychotherapy and is only “talk therapy."

You're not alone; everyone has sexual problems at some point. While the media paints sex as easy and hot and suggests that everyone but you is having loads of sex, the truth is that having great sex takes work. Young newlyweds often have sexual adjustment problems of the who (initiates), what (is exciting to you and me) and when (morning or night) type. Couples with young children are often exhausted and have trouble keeping the bedroom a priority, leading to fights and feelings of relational doom. Older couples struggle with menopause, malepause, and old relational resentments that can shut down sex. And everyone must deal with the struggle over closeness and space, in marriage, where one person is more of a chaser (pursuer) and the other is more of a chasee (distancer), which is the essential difficulty in maintaining sexual desire.

But what happens in sex therapy? And how can simply talking about it help your sex life? How bad should it get before we consult an expert?

1. Sex therapy helps couples talk about sex with each other. A sex therapist feels comfortable talking about sex. While nothing is off-limits and nothing is taboo to talk about, most people have trouble bringing up anything when it comes to sex. Couples don't have an erotic language to describe their wishes. Women don’t talk to their girlfriends about how they renew their sexual desire. Men don’t ask their guy friends how to bring a woman to orgasm (certainly not!). Most doctors don’t have even one day of sex therapy training in medical school, even gynecologists and urologists. Physicians are good at talking about how the body works but limited by their own experience when it comes to solving sex problems.

Sex therapists are aware of how anxious you might feel talking about this intimate subject with each other and with a near-stranger. They will help set you at ease and guide you into talking about sex.

2. Sex therapy gets to the root of the problem. Couples often can’t solve these intimate issues on their own because disappointment, hurt, anger, resentment, accusations, inhibition, and several rounds of fighting might have shut down the very discussion most needed. Research shows that most people who could have easily solved their problems wait six years before seeking help! Anxiety is the number one reason people don’t pick up and call for help. Fear of confronting the problem and discovering that they are truly not compatible is so powerful that they delay and delay, feeling more hopeless every day. But most often, a couple in sex therapy finds a way to feel more pleasure and more joy.

3. What happens in sex therapy? When a couple comes into my office, the first thing I want to know is what is hurting them. I use the forms (you can see them on my site and use them to start a discussion with each other) they fill out to compare with what they’ve told me. Next, I offer separate interviews with each partner. You’ll be asked about your sexual/relational history sometimes in the private interview as well as questions about your childhood, your parent’s marriage and what they taught you directly and indirectly about sex. I can see the road map for how to solve the problems and we set out on the work. Eventually, after both parties feel deeply understood and supported—whether they want more frequency or more emotional connection first—then, I might assign touching homework.

4. Sex therapists have hope and are fair. I have rarely encountered a problem between two ordinary people that I didn’t feel was somehow workable and resolvable. I’ve been a sex therapist for 18 years and a marital therapist treating sexual problems for 28 years and have treated thousands of couples in person and with online sex therapy. Often one partner needs sex in order to feel connected and the other needs to feel connected before they want to have sex. Both sides of the problems must be understood and worked through for a fair solution.

5. What kinds of problems do sex therapists treat? The top two problems in my practice: low sexual desire and frequency disagreements between partners. (I’ve written a book called Wanting Sex Again to help with the first one.)

  • Women who want to have their first orgasm; or want to orgasm with their partner
  • Men with premature ejaculation
  • Erectile dysfunction
  • Delayed ejaculation
  • Breast cancer and prostate cancer survivors
  • Technique problems
  • Learning to enjoy oral sex
  • Getting over the “ick” factor feelings about different sex acts
  • Porn addiction or sex addiction
  • Boring sex lives
  • Not attracted to their partner
  • Can’t get aroused
  • Can’t tell your partner to brush his teeth
  • Inhibitions of all sorts
  • Fetishes

6. How long does sex therapy take? Three levels of problems take different lengths of treatment.

Level 1 - Sexually oriented problems: For instance, a young woman doesn’t know how to have an orgasm; usually takes two sessions or less. Premature ejaculation is easily solved before resentment sets in... get help fast! A question you can’t ask anyone else. I’ve had single sessions that have relieved people from a lifetime of wondering and worry. Is it normal to think about X? Is it normal that my penis has a curve? Etc.
Level 2 - Sexual problems entangled in the relationship: The bulk of the couples I see have sexual problems tied up in the knot of their power struggle with each other. Sex serves as a perfect battleground to work out deeper issues about how close each wants to feel and how much autonomy they want to be granted in the marriage or partnership. This often takes at least 15 weeks to six months and involves marriage counseling or couples counseling as well.
Level 3 - Trauma, childhood histories of neglect or abuse, difficulties feeling connected to anyone—sexual problems resulting from these issues can take years to resolve. Not every person who was molested needs years of therapy to have a happy sex life, but some do, depending on who the abuser was, how long it lasted, and if violence was involved. Feelings of sexual deadness are often a defensive pattern from childhood vows to never trust another with one’s primitive needs and often need a longer therapeutic treatment.

7. Is my sex therapist a Christian? Obviously, for many people, sex therapy is in moral territory and there is a real worry that they might be led astray by an authoritative voice. But sex therapy is not amoral but is sensitive to the faith and cultural background and values of the patient. Yet it is also a non-judgmental place to safely explore the erotic mind. Most sex therapists or other psychotherapists do not talk about their personal lives or advertise by way of faith alignment. Personal information should be shared if it is relevant to the treatment.

8. What if I get turned on talking about sex with my sex therapist? Most sex therapists keep a balance between warmth and professionalism that makes talking about sex really comfortable. Sex therapists are aware of how intimate talk engenders sexual feelings in many if not most people. A client getting turned-on or having a sexual fantasy that includes the therapist is common and important to analyze in the therapy. Strangely enough, these fantasies often contain rich meaning about the client's inner world. Sex therapists have firm ethical boundaries about NOT entering a sexual relationship with any client for this very reason so that all the content of the therapy can be understood appropriately instead of acted upon. Again, sex therapy never includes sex with the therapist.

More from Laurie J Watson PhD, LMFT, LPC
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