Sex Therapy: What You Should Know
What is sex therapy?
Sex therapy is a specialized form of therapy that helps individuals and relationship systems address physical, emotional, mental, and relational challenges to having a satisfying and vibrant sex life. Sex therapy helps you cultivate or regain a sense of confidence and groundedness in your sexual identity. Sex therapy can also help you explore aspects of your identity and relationship dynamics! Common reasons people seek sex therapy is for help with mismatched desire–you and your partner have different wants around frequency and kind of intimacy, difficulty reaching orgasm, erectile difficulties, eager/premature ejaculation, pain with sex, fear of sex, dating anxiety, conflict around intimacy, and more.
How does sex therapy work?
Similar to traditional therapy, sex therapy involves your therapist getting to know you through a thorough assessment process to understand how you came to be a relational and sexual adult. Together, you’ll collaborate on treatment goals and your therapist will share their treatment plan to support you reaching your goals. Often, treatment involves a combination of behavioral, cognitive, and emotional skill building and exploration. Depending on what you’re coming in to work on, your therapist will likely assign homework that involves exercises that support deepening the mind-body connection and supporting your relationship (if that’s part of your therapeutic goals!). Sex therapists differ in their approaches and some are more brief, behavioral, and solution-focused in their approach while others take a more holistic approach that considers your environment, relational contexts, emotions, and the ways you make meaning of your experience and struggles.
When should I see a sex therapist?
Most people seek out sex therapy when the impact of their struggles becomes difficult to tolerate. Maybe you’ve always struggled to reach orgasm but now you’re in a new relationship and that struggle feels painfully acute, or your partner has urged you to seek support for your erectile difficulties. Perhaps you’re in your first serious relationship and really struggling with vulnerability around physical intimacy, or want to try penetrative sex for the first time and you’re too afraid of pain to attempt it. People often reach out to therapists in crisis and while we’re prepared for that, it’s worth acknowledging that change takes time and requires patience, willingness, and a commitment to the process. My invitation is to consider sex therapy before it becomes critical because the presence of distress doesn’t have to be the only catalyst for change, it can also be the absence of pleasure, expansion, a felt-sense of safety, etc.
Considerations
Fit: As stated above, not every sex therapist works in the same way so you may need to consult with several before you find your ideal fit. Consider what kind of approach appeals to you: do you want someone who is going to be very directive and solution oriented, giving you behavioral exercises and keeping the focus solely on the “dysfunction” you’re coming in to treat? Do you want a therapist who is going to be more curious, exploring with you the struggles of your experience and supporting you to adopt alternative strategies or ways of viewing yourself/your struggles? Also consider identity: is it important to you that your therapist share similar identities as you do? Is there a cultural consideration for you and if so, how important is that in determining a good fit? Finding a therapist is a lot like dating so if the first person you find isn’t meeting your needs or expectations, it’s important to keep going and find someone that does because research shows that one of the biggest factors in the change process is the level of comfort, trust, openness, and reliability within the relationship between you and your therapist.
Couples vs Individual Sex therapy: If you’re in a relationship and struggling with aspects of your body, sexuality, pleasure, etc. it can be hard to discern if your partner needs to be present as well. It can be helpful to consider if this is a relational struggle–such as mismatched desire which exists in the context of two or more people, or a struggle that is exacerbated by or impacts the relationship. If it’s in the later categories, it’s up to your and your partner to determine what would feel the most helpful and supportive. For example, some folks might really want their partner present to support them and allow the partner to better understand what’s happening for them while others may struggle with the idea of being open and vulnerable about their struggles in front of their partner in which case individual therapy would make the most sense to support capacity and willingness. If you’re really unsure, you can always rely on your therapist to help you determine a course of action.
Capacity for change: Many people come to therapy eager and willing to change some aspect of their internal or external world. For change to be possible, in addition to willingness and commitment, we need capacity. Capacity means we have the literal space, time, and energy in our life to dedicate to the change process. Willingness to change often means accessing willingness to be in discomfort, and tolerating discomfort also requires capacity. If our day-to-day is overwhelming, jam packed, unsafe, etc. it’s going to be hard to move through the therapeutic process and develop the self-awareness, skills, and mindset shift required to meet goals. Part of your therapist’s job is to help you build capacity so if capacity feels slim or taxed right now, that’s ok! Just be aware that the beginning of therapy may focus on building capacity for the work you’re coming in to do, rather than the work itself.
Summary
Eroticism in all its aspects is a source of worry and anxiety for many people, for really good reasons. If sex, sexuality, and your identity cause distress and discomfort for you, you are worthy of help and care. You deserve an abundant, easeful, and vibrant erotic life. Societal conditioning and mind-body disconnection make it so hard to access that kind of erotic experience. Sex therapy, especially holistic sex therapy that addresses all aspects of your personhood, identity, and view of self/other, can be a huge support to cultivating and inviting an integrated, pleasurable, and accessible relationship with your sexual, gender, and erotic identities.