Therapist Blog

What Really Happens in Sex Therapy?

Frequently when someone calls for information, what they want to know most of all is, what happens in sex therapy?  They are reassured when they hear that sex therapy is like any other psychotherapy.  One of the most important parts of the relationship between the sex therapist and client is that everything is confidential (with some legal exceptions, like reporting child abuse).  That way, a client can be assured that whatever they disclose in therapy will not be told to anyone else, ever, without a release of information signed by them.

The process of sex therapy is also similar to other psychotherapy.  Sex therapy happens in stages.

Stage I:  Intake call.  In this brief exchange, the sex therapist listens to see if the client is someone they think they can help.  Sometimes, the therapist has too many of one type of client or isn't especially expert at what the person calls about.  Sometimes the client wants a therapist who offers a certain type of treatment, or they are looking for a sliding scale.  The therapist needs to determine if it will be worthwhile to set up an evaluation.

Stage II:  Evaluation.  During this stage, the therapist is gathering information about the problem.  The therapist wants to know when the problem began; if it happens all the time, or only under certain conditions; what kind of distress the problem causes; and what has been tried already to solve the problem.  The therapist is also noticing things about the client such as whether they are talkative or not; how much insight they have; and how motivated they are for change.  The evaluation may take 1-3 sessions.  Therapy does not take place during the evaluation.

Stage III:  Goal Setting and Treatment Planning.  After gathering information, the therapist sits down with the client (who could be an indidivual or a couple) and shares observations.  The therapist and client also discuss realistic treatment goals.  A course of treatment is set and may include psychotherapy of different types to address the problem.  For example, a person might have distorted ideas about some part of their sexuality that need to be addressed so that they feel better.  Or a couple might have problematic interactions that interfere with being intimate.  The sex therapist may also assign "play assignments" such as special touching activities to do at home to help overcome anxiety and increase sexual confidence and interest.

Stage IV:  The Middle Stage.  This is the core of therapeutic change.  The client learns things in therapy and tries to apply them to real life.  They report back what worked and what didn't.  The therapist makes changes in the treatment plan according to what is needed.  This stage may take a few weeks or several months.  There is periodic re-evaluation of treatment goals and checking in to see if therapy is effective and beneficial.

Stage V:  Reaching Goals.  Provided that the client has worked in earnest, change happens and goals are met.  Sometimes there are new goals, but sometimes the client and therapist decide that their work is complete.

Stage VI:  Termination.  Therapy comes to a close.  The therapist and client review the work they have done together.  The therapist may discuss what signs might occur that mean old habits or thoughts are returning, and recommend coming in for "booster sessions" to stay on track.  Therapist and client say good-bye.

Most sex therapists know how to treat every kind of sexual problem, but they may also have an area with specialized training.  For instance, I have a subspecialty in treating sexual pain disorders.  Someone else might be highly specialized in treating people who have kinky problems.  Another person might treat only sex addicts. 

Sex therapy can definitely help clients who are motivated to change and who have an open mind to trying new ideas and behaviors.