What a Sex Therapist Is Really Thinking

1
What a Sex Therapist Is Really Thinking
How does sex therapy work?
I will spend five to six sessions doing a
thorough assessment, which includes getting
details of the history of the problem and
finding out about each partners familial and
sexual history, including sexual trauma. A
sexual history helps me understand the verbal and
nonverbal messages a client received as a child
about what sex might be like. If a child
remembered her parents enjoyably flirting with
one another and expressing love through kisses
and date nights, they received a
2
message that it is OK to have these feelings and
that long-term couples can have enduring sex
lives. If a child grew up with messages of shame,
anger, and isolation around the topic of
sexuality, they feel shame about their own
desires and try to suppress them. I also ask
about the relationships a person has had in the
past that contributed to their attitudes about
sex. Then I ask the couple what they have done to
try to fix the problem. And I inquire about each
persons history with other medical professionals
including urologists, primary care physicians,
therapists, psychiatrists, gynecologists and
endocrinologists. I feel it is critical for all
treating professionals to work as a holistic
system. Clients can expect to attend weekly
sessions and for the sex therapist to help them
become more comfortable talking about their
sexual issues in detail. Sometimes, problems are
treated and improved within 10 sessions, other
times they may take six months to a year or more
to address. Certified sex therapists have to be
licensed in a mental-health discipline and use
only verbal communication with their
clients. Do you give homework?
I encourage clients to engage in activities
between sessions so that they begin to integrate
their learning and put it into action. In terms
of communication, what is sexy? I tell my
clients Just as beauty is in the eye of the
beholder, sexy is in the eye (or ear, touch,
etc.) of the partner. The difficulty is figuring
out what youre into and what your
3
partner is into and being able to talk
confidently about it in a way that your partner
can receive without negativity. Some people
respond to sounds or conversations as their
erotic trigger while others are much more visual
and would like to see their partner in certain
clothing or positions as a signal. For many
people having these conversations of what theyre
looking for in terms of triggers can be
challenging since theyve received little to no
education except what theyve seen in films or
books. How often do the couples seeking therapy
have sex?
There is no average of frequency in my couples.
Some couples have sexual activity once a week,
others a handful of times a year. Still others
have some type of sex five times a week. My goal
is to help them come to a realistic agreement
based on their desires. How do you get someone
to open up? I connect with a client by asking
them about their lives, who they are beyond the
problem theyre bringing in to discuss. People
are anxious their first time meeting with a sex
therapist so it is helpful for both to discover
the areas of their lives in which they have
strengths before asking them about the problem
they want to discuss. Ill also use humor if the
person is open to it, since I find it can be
relaxing and potentially healing. What is the
best way to maintain attraction in a long-term
relationship?
4
Keeping up an erotic connection takes a
mindfulness that both partners need to practice.
Just because you fell in love and there was a lot
of passionate attraction in the beginning, you
cant sit back and expect it to continue. You
have to keep flirtation, seduction, novelty and
surprise going on a regular basis so that you and
your partner continue to play together. Sex
isnt just a matter of moves and techniques but
also a sense of entitlement to relax and fully
immerse oneself in intimacy, pleasure and
play. Does lack of sex typically precede other
problems, or do couples typically have other
problems that lead to a lack of sex?
The answer is both. There are couples who have a
negative communication pattern that leads one or
both partners to avoid sex. If a person feels
their partner continually shuts their concerns
down with defensiveness, contempt or iciness,
their conflicts never get resolved but are swept
under the rug. There are also couples who
gradually lessen the amount of sexual contact
until it becomes very infrequent or avoided
completely. Although they may love and enjoy
spending time with one another outside the
bedroom, one partner generally sounds the call by
contacting me or having an affair. These are
couples who arent only avoidant of sexuality but
avoidant
5
of conflict in general and repress their
frustration and sadness about the lack of sex.
Theyre usually too anxious to bring it up in a
direct way out of fear of the answer. I can help
them navigate what led to the avoidance and give
them guidance on reinvigorating their sex life.