Sex therapy is not what you think. Here’s why

Let’s face it, for many people, there are times when the fireworks may fizzle a little—or a lot. Many things can get in the way of healthy sex, such as communication breakdowns, past hardships, working on understanding your sexual identity, or physical or medical issues. Whether or not you’re in a relationship—or somewhere in between—sex therapy can help you understand what’s going on so that you can feel more comfortable between the sheets.

What does a sex therapist do?

The first thing to know is that sex therapy is, like other types of counseling, talk therapy. If you schedule a session, the office will look like a regular therapist’s office, not the playroom in 50 Shades of Grey.

Not only that, but the therapist will not touch you in any way, nor will the therapist observe you having sex, according to Ian Kerner, PhD, a licensed marriage and family therapist and certified sexuality counselor in New York City. Dr. Kerner says that in working with clients, he can’t help but get into relationship and communication issues.

"I'm always working with what happens outside the bedroom and what happens inside the bedroom,” Kerner says. That’s why all certified sex therapists are licensed to work in other disciplines, such as psychology, clinical social work, or counseling as well, he notes.

Who needs a sex therapist?

People seek help from a sex therapist for a wide range of reasons. Problems with sexual functioning and pleasure can be psychological or physical in nature, and sometimes a combination of the two. Sex ruts, sexual boredom, and incompatibility can quash your desire for sex.

Erectile dysfunction—when the penis doesn’t become or stay erect—may be caused by a medical condition, like diabetes or high blood pressure, performance anxiety and other types of stress. Problems reaching orgasm can be related to personal or relationship problems, like memories of past sexual experience, conflicts or lack of intimacy within a relationship, as well as physical problems like diabetes or endometriosis.

What’s more, alcohol, smoking, and certain medications like SSRIs and blood pressure medications can affect sexual function regardless of your sex.

What kinds of issues can a sex therapist address?

According to Kerner, common sexual issues for males include:

• Erectile dysfunction
• Delayed ejaculation
• Premature ejaculation
• Wanting sex more frequently than their partner
• Sexual behavior that interferes with daily functioning, such as porn addiction

Common sexual issues for females include:

• Low sex drive
• Lack of arousal
• Inability to orgasm
• Pain during sex

Finding help

If you’re experiencing sexual or related relationship issues, a sex therapist may help. Here’s how to choose the best one for you:

Consider the therapist’s credentials. Be sure that the therapist is trained and has experience working on sexual issues. If you’re seeking help as a couple, check that the therapist has experience working with couples. One way to find a therapist specifically trained in sex therapy is through the American Association of Sexuality Educators, Counselors and Therapists. You might also ask your primary care physician, OBGYN, or urologist for a recommendation.

Call the therapist for a brief consultation. “I always do an initial consultation on the phone to make sure I’m the right fit,” says Kerner.

Ask about the therapist’s approach, frequency and length of sessions, fees, and schedules. “Everyone works differently,” Kerner says. “I prefer to see clients every other week, and the sessions are 85 to 90 minutes.” Other therapists may want to see you every week, for 45 minutes to an hour.

Schedule a first appointment. In meeting with the therapist, you should feel comfortable discussing your problems, and come away with a sense that the therapist can help you. If you don’t feel a connection, you’ll need to try another.

Starting sex therapy

During the first session, expect to do a lot of talking about what’s happening in your life. Kerner says there are three things he wants to learn by the end of the first session:

• A detailed description of the problem.
• How the problem is expressed in the client’s sex life. “There’s a series of behaviors that come together to create what I call the sex script,” he says. “I want to know where in the sex script the problem is happening.”
• The desired outcome: Kerner explains that he wants to know how the client hopes to experience sexuality as a result of therapy

You may have some homework to do

Many sex therapists, including Kerner, give clients homework to complete between sessions. The homework is typically a weekly assignment, but it isn’t necessarily one that will have you spending time in the bedroom. Instead, it’s a behavioral technique that can help you deal with any physical symptoms and/or learn new ways to be intimate and experience pleasure during sex.

“Let’s say a woman finds she’s not experiencing desire,” Kerner says. “One assignment might be an exercise in generating arousal.”

For example, you and your sex partner would agree on an activity one week, like giving each other sensual massages or taking a sexy shower, for 20 minutes at a time. If one partner is experiencing distress because of premature ejaculation—that is, having an orgasm soon after intercourse begins—the therapist might assign techniques to help the client withstand stimulation for progressively longer periods of time.

Sometimes the homework may not have a physical component. Rather, you may be asked to explore thoughts or feelings on a given topic, or find verbal ways of showing affection and appreciation for yourself or your partner.

How long does it take to improve your love life?

“It depends on whether something is really enmeshed in a client’s life,” says Kerner. Issues like infidelity or feeling alienated or disconnected from your body or exploring your sexuality could take more time. For clients in a couple, Kerner says it’s not uncommon to do a combination of sex therapy and couples’ therapy.

Kerner notes that for pure sex therapy, where a client has a specific issue to resolve around sexual functioning, it could be about 6 to 10 sessions. It could take longer, depending on the therapist and the issues the client wants to work on.

So, is addressing a sex problem worth the effort?

One thing to consider: Ignoring issues can make life even more difficult in the long run, leading to frustration and unhappiness. But learning to improve communication and overcome obstacles could lead to a richer, more fulfilling life both in and outside the bedroom, a deeper connection with yourself or your partner, and even better health.