What is Sex Therapy?
Psychotherapy has become a widely accepted form of treatment for many problem, however, there are still at times questions about the various types of psychotherapy, and the licensed professionals offering it. Psychotherapy is a form of counseling through talking with either a therapist or in a group format to addresses psychological disorders and the associated physical symptoms, emotional distress and/or decreased cognitive function in daily life. Psychotherapists become licensed by their specific state in a variety of disciplines including clinical social work, psychology, psychiatry, counseling, and marriage and family therapy.
Sex therapy by extension is an additional level of training above and beyond the traditional requirements of the disciplines and licensures listed above. The American Association of Sex Educators, Counselors and Therapists is the main certifying organization in the United States. An AASECT Certified Sex Therapist has completed many hours of didactic education around all aspects of anatomy, sexual disorders and their treatment and cultural and biological underpinnings of major sexual disorders. They have also completed 50 hours or more of supervision of their cases. Sex Therapists see individual clients or couples who are dealing with a sexual problem or disorder that is interfering with a healthy, pleasurable sexual partnership whether it be with a longtime partner or within a casual or dating context.
Common presenting problems a sex therapist will treat include:
- Discrepant desire between partners
- Erectile Disorder
- Low Desire in women (AKA as Female Sexual Interest/arousal Disorder or SIAD)
- Low Desire in Men (aka Male Hypoactive Sexual Desire Disorder or MHSDD)
- Painful Sex (Genital Pelvic Penetrative Pain Disorder or GPPPD)
- Compulsive sexual behavior or Out of Control Sexual Behavior
Sexual practices have existed for several centuries-spanning diverse cultures from the ancient Greeks, Indians, and Romans through today’s kink and Polyamory lifestyles. Included in these practices are ancient India’s Kama Sutra and Tantra, dildos used by ancient Greek women, Nida purity laws of Hasidic Jews, rapes by victorious warriors/soldiers and early American slave owners, and modern Americans’ increase in premarital sex and cohabitation. Alternatively, sex is viewed by many as a spiritual union between people, a blessing to God, and a requirement for procreation depending on what class you were born into, or what religion you practice.
An AASECT Certified Sex therapist approaches problems from a sex-positive attitude and conducts a bio-psychosocial assessment to identify all contributions to the issue being presented. What this means is that there may be a biological or medical issue that needs to be treated in addition to the psychological symptoms. There may be a systemic aspect of the problem as well when it involves partners in a relationship. Finally, each person comes from a unique family, a specific cultural community and perhaps a religious background that has each played a part in the attitudes one has towards their sexuality. Sometimes a sex therapist will work collaboratively with one or two medical providers who are also treating the client. This ability to work on a team and assess with a multi-disciplinary lens is why it’s important that sex therapists have several years of therapeutic experience under their belt before getting their post-graduate training in sex therapy so they are able to assess, diagnose and treat presenting issues on many levels.
In some cases, clients come in with coinciding psychiatric disorders that haven’t been assessed or are being treated concurrently with a psychiatrist. At other times a client is ready to address the sexual or physical trauma they suffered earlier in their life due to the way it has created a barrier to pleasurable sex.
The Mind as a Sexual Influence
Sex Therapy frequently also addresses anxiety, depression, obsessive thoughts, shame or low self-esteem due to negative body image which restrict sexual intimacy and pleasure. These feelings may prevent a person from feeling present to the sexual stimulation a partner provides complaining they’re “too in their head”.
A common misconception about sex is that it solely involves stimulation of genitalia to achieve physical arousal. However, the mind is just as or in some cases more critical to erotic turn on. The brain is a complex network of systems that is a driver of erotic thoughts, emotions, and subsequent physical reactions. For some people, if the mind can become relaxed enough, a person can be more open to receiving sexual sensations even if the body is not initially sending physical signals. This is true for many women who may be too exhausted, or hormonally challenged to experience physical signs of horniness but can enter an erotic zone with the right relaxation and seduction, intimacy from a partner or entertainment on her own. Women need to listen to their own sexual pacing and communicate explicitly to a partner what they need, what their limits are and how they enjoy intimacy each time they’re intimate. For men who are fearful of losing their erection, of being rejected or humiliated, many times they need a slow series of positive affirmations and flirtation and massage before his body begins to respond physically. Men are unfortunately expected by society to be ready willing and able to be sexually performative even when they don’t feel like it.
In many cases of sexual abuse, the mind and body have united to protect the survivor from further abuse through a system of trigger points that are extremely sensitive and specific. For some survivors, certain types of touch, or specific areas of the body or smells can trigger a cascade of PTSD symptoms even if they’re with a partner they know is safe and loving. Even when sexual interaction is consensual and genuinely wanted, the mind/body has encoded the same reactions the person had when they were abused once a point is triggered. It is extremely important both for the survivor to get help if they want to re-discover a pleasurable sexual life but for their partner if they’re in a relationship since a partner can develop their own symptoms in reaction to the survivor’s sexual rejection or avoidance.
Compulsive sexual behaviors are another presenting issue one can address in sex therapy. Without interventions, the behavior can affect not only your self-esteem, your sexual life within relationships, one’s career, and one’s mental and medical health. Also referred to as hypersexuality, or out of control sexual behavior, compulsive sexual behavior is a series of sexual experiences that may not even feel pleasurable and feel out of control of the person engaging in them. There are a variety of possible underlying causes that may result in hypersexuality that require a full assessment of biological, psychiatric and familial history.
Orgasmic Dysfunction occurs when it is difficult for a person to achieve orgasm even when ample sexual stimulation and arousal are present. This can happen to both men and women for different reasons. While some women have not been encouraged to teach themselves how to masturbate to orgasm or feel extreme shame or disgust for their vulva, other women may have other biological reasons that slow down the process of reaching orgasm even with stimulation. Other women may be too anxious or disassociated to be fully present in their bodies to receive the full experience of genital stimulation and are a sign of mental or emotional limitations. Essentially, orgasms are a release of sexual emotion and pleasure which vary in duration, frequency, and intensity from person to person. Orgasmic dysfunction or anorgasmia occurs when there is a sexual pleasure but no sexual release. This can cause frustration, discomfort, and increased or decreased sexual appetite.
Methods used in Sex Therapy
The primary methods of sex therapy involve a therapist taking a history of the presenting problem with an individual or couple, conducting individual sexual histories with each partner and exploring familial, cultural and medical histories of each client to create a full assessment of the problem. Through this, the therapist listens and comes to understand the root of the problems that the individual is facing. Using a PLISSIT model (stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy) model to decide what aspects of education might be useful, a sex therapist will reflect back to the clients what they think the main issues are and invite them to ask questions before they agree on a treatment plan.. Most of the time, medication is not prescribed but if there’s a question as to whether a medication could be helpful or is part of the presenting problem the therapist will refer a client to a psychiatrist or other medical provider to gain their expertise. In other cases involving vulvar, pelvic or genital pain, a therapist might collaborate with a pelvic floor physical therapist. In most cases though, the therapist will look more for the psychological and systemic causes underlying the initial cause and persistence of the problem.
Depending on the complexity of a presenting problem, sex therapy treatment may only require a brief number of sessions. In cases of problems that have a longer history (like sexless relationships for years or history of childhood sexual abuse/trauma that has never been addressed). These sessions may be done with an individual, in a group, or jointly with a partner. It is also likely to involve more “homework” assignments.
These include communication exercises, changes in sexual practices, and the like. The therapist will describe the nature of the exercises and then process the observations and experiences of the exercises the week following the assignment. Some therapists utilize exercises within the session (clients are always fully clothed) to help partners learn how to communicate more effectively or learn how to initiate a sexual encounter or find new ways of comforting a partner when they’re hurt.
AASECT Certified Sex Therapists may have additional professional credentials to assist in other psychological issues and treatment methods. For example, they may be trained in EMDR, a specific type of treatment useful with those coping with intrusive traumatic flashbacks. Or they may be trained in Hakomi or Somatic Experiencing that bring more embodiment exercises into the treatment when clients complain of being cut off from their sensory experiences during sex.
Why Sex Therapy is Important
Sexual pleasure is an important part of many people’s lives, whether within a committed relationship or in casual dating. It can express love, intimacy, closeness, playfulness, freedom, and trust. Sex shouldn’t be the source of frustration, pain, or discomfort. When it does, it is important to attend to any possible issues that may be causing an obstruction to freedom of expression or enjoyment in general.
The goal of sexual therapy is to assess, diagnose and treat underlying psychological, emotional and systemic causes that result in sexual dysfunction. Through talk therapy, those suffering from sexual problems can begin to understand their origins, begin to learn facts vs. myths, how their cultural backgrounds have contributed to their issue and how the relational patterns they may have created with their partner(s) have caused their relationships system to become stuck. Through new techniques and bibliotherapy or video therapy tools, clients alter their preconceptions and work towards rewriting their sexual narrative for themselves and their relationship.
General Causes of Sexual Dysfunction:
- Lack of good enough sleep
- Erectile Performance Anxiety
- Dissatisfaction or conflict within a relationship
- History of sexual abuse
- Pre-existing mental health conditions (e.g. Depression, OCD, Anxiety Disorder)
- Recent medical procedures
- Imbalance or side effects of pharmaceutical drugs
- Guilt, shame or embarrassment
- Insufficient amount of sexual stimulation
Good sex therapy like other talk therapies, at its ideal should be tailored to your unique sexual life.
Discomfort, pain, shame, guilt and other negative emotions that you may feel in relation to sexuality can limit your psychological and sexual connection with people. From common concerns to specific issues, sex therapy allows you to explore your underlying preconceptions to sex, emotions, and more.
At times, the manifestation of a problem sexually may have more to do with one’s psychological disorder or physical ailment than with lack of sexual knowledge or technique. This makes it doubly important to seek professional help in order to determine the real source of your sexual concerns.
When to Seek a Sex Therapist
When deciding to see a sex therapist, it is important to note that sex therapy is much like other forms of counseling and therapy. Contrary to popular belief, there is nothing strange about seeking help regarding issues of a sexual nature. More importantly, sex therapy can help resolve the issues somewhat quickly
You should seek out a sex therapist when:
- issues of a sexual nature become more than a one-time occurrence and begin to develop particularly negative patterns. Such patterns can become habitual and begin to negatively affect other areas of your life if not addressed.
- you’ve tried severally to correct the issues yourself but don’t seem to be making any progress, it can inspire frustration, or even a loss of hope, especially when the cause of the issue is unclear. Sex therapists are specifically trained to identify and resolve such issues.
- your sexual thoughts or acts are a source of discomfort, it may be hard to find someone to talk to about them. A therapist provides an open, non-judgemental, and encouraging environment to help nurture discussion.
- your body undergoes major changes that you may or may not fully understand whether due to pregnancy, injury, illness, hormonal changes, sexual transition and naturally due to age. From circulatory and neurological problems to more common issues like erectile dysfunction, or decreased lubrication, a sex therapist can help you understand and embrace such changes.
- You feel too ashamed by specific sexual interests (like BDSM, Poly, fetishes ) to bring up to a partner or to practice in a group.
What to Look for in a Sex Therapist
It’s best to work with an AASECT Certified Sex Therapist or a therapist working toward their certification under supervision. Sex therapists are licensed therapists who have completed additional training and certification to give them a more didactic and supervisory experience to provide appropriate treatment. The ideal sex therapist is one who will put you at ease and help you to understand yourself better. It may help to see a therapist who has a practicing medical background if you are concerned that the cause is related to some physical aspect, but it may not be necessary and your therapist should have a good network of medical providers to whom they can refer you. Your alliance is essential in this matter so you feel comfortable sharing honestly about what is for most people the most intimate part of their lives.
More than anything, you need a therapist who is open, understanding and is willing to provide therapy at your own pace. Therapy is an especially individual and unique experience that requires your complete comfort and trust in your therapist. There’s no shame in needing to see a few therapists before finding one you feel comfortable with. If you have any problems being open or confiding in your therapist, feel free to share that with them. It creates an awareness of your needs and only serves to help them better understand you.
Feeling embarrassed or awkward? It’s common for people to feel shy at first when first discussing their sex life with a therapist. However, your therapist should be able to put you at ease, reassure you that they have heard many stories and that they are to help. Like any good therapist, there shouldn’t be any judgment or pressure to discuss topics if you’re not ready to. If you are not completely comfortable talking about certain things at any given time during the therapeutic process, simply let them know you may need more time before exploring an issue and move on to a more comfortable topic. At all times, your emotional safety takes priority. It is also important to remember that therapy is a journey, not a one-step solution. As you attend more sessions, you’ll find yourself slowly opening up and making progress. Each person is different so don’t expect to keep pace with your partner or other people.
Growth and development are a key part of human development including learning, sharing new experiences and establishing emotional bonds with others. Sex Therapy supports clients in their efforts to add new skills to their repertoire, share desires with a partner and increase their pleasure and sexual mastery.
It’s important to understand that sex therapy is exclusively talk-therapy. AASECT Certified Sex Therapists clearly state in their Ethical Guidelines (as do many licensed therapists) that no touch shall be involved. If someone offers to do hands-on work or conduct sessions in the nude, they are clearly NOT sex therapists. Make sure that your therapist is credentialed by the American Association of Sexuality Educators, Counselors, and Therapists and/or a related graduate therapy degree with a license to practice therapy. Additionally, some sex therapists will recommend that you have a physical conducted to ensure that there are no medical issues causing or contributing to the problems. To find a sex therapist in your area search TherapyTribe.
Jack S. Annon (1976) The PLISSIT Model: A Proposed Conceptual Scheme for the Behavioral Treatment of Sexual Problems, Journal of Sex Education and Therapy, 2:1, 1-15, DOI: 10.1080/01614576.1976.11074483
Wall Street Journal (2016) What is a Sex Therapist Really Thinking Retrieved July 17, 2017, from https://www.wsj.com/articles/what-a-sex-therapist-is-really-thinking-1468862093
International Society for Sexual Medicine (ISSM) What happens during sex therapy? Retrieved July 2017, from https://www.issm.info/sexual-health-qa/what-happens-during-sex-therapy/
Althof, S. (2010) What’s New in Sex Therapy, The Journal of Sexual Medicine Volume 7, Issue 1, Part 1, Pages 5-13 https://doi.org/10.1111/j.1743-6109.2009.01433.x
Binik, I. and Hall, K. Principles and Practice of Sex Therapy 5th Edition, (2014), Guilford Press, New York, NY
American Association of Sexuality Educators, Counselors, and Therapists AASECT (2014) Position on Touch and the AASECT Certified Professional Retrieved July 2017, from https://www.aasect.org/position-touch-and-aasect-certified-professional
American Association of Sexuality Educators, Counselors, and Therapists AASECT (2014) Code of Ethics Retrieved July 2017, from https://www.aasect.org/code-ethics