How do I know if I need a sex therapist?
Psychotherapists, psychologists and related professionals (licensed professional clinical counselors, marriage and family therapists, licensed social workers, psychiatrists) are trained to address relationship issues and problematic behaviors and feelings. If they were trained before 2012, (most licensed clinicians were because it takes several years to get licensed) they were not required to take any courses specifically that addressed sexuality. Those who were trained recently only received 10 hours of coursework about sexuality.
These 10 hours of coursework ends up feeling like a drive-by tour of sexual behaviors, assessments and interventions and can be said to be wholly insufficient for people’s experience of sexuality today. For the most part, these professionals regardless of when they trained, will spend time working on the feelings, relationship conflicts and issues brought to their attention without addressing any of the issues of sexual dysfunction and dissatisfaction directly. They may ask about sexuality and may refer clients to their medical provider if they hear of pelvic pain, lack of desire or arousal. They may also inadvertently support clients who are experiencing desire discrepancies with partner(s) to exit a relationship that seems to not be working through supportive therapies.
Assuming there is no medical reason for the sexual issues (and a referral to a medical provider can quickly confirm this), a sex therapist would spend time understanding the specifics of the problem in context. When does it occur? What have you tried so far? Who initiates sex? How is this communicated? Are there stressors or anxieties about sex? What are they? Is each person aware of what they like or prefer? Can they communicate this successfully in the moment? Are there any beliefs that the parties have about this situation that are unfounded? Would some specific coaching be helpful (e.g. new positions, different lube, different birth control, types of touch)? Do they need to develop a stronger connection or some dynamic tension or eroticism in the relationship? Are there fantasies that may be helpful to explore? How do they touch one another, make eye contact, use voice and space to indicate intimacy or eroticism? What effect would there be to consider increasing, decreasing or changing porn use, masturbation behavior, substance use, medicines, and other factors that may be implicated in the quality of partner sexual experience? All of these would help the sex therapist work on the level of cognitions, beliefs, feelings, and behaviors to support a healthy and satisfying sexual relationship with oneself and one’s partner(s). In addition to these common issues, sex therapists are skilled in addressing the needs of kinky clients, sex workers, LGBT people, poly and non-monogamous relationship structures and those who have experienced sexual trauma.
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