Sex Therapy

How does Sex Therapy work?

As a sex therapist, I focus on the physical relationship between two people in a relationship, then identify the couple’s attitudes about sex and the sexual problem. From there, I’ll often recommend specific exercises to refocus the couple’s attention and expectations.

Specific objectives may include the following:

• Learning to eliminate and relax distractions
• Learning to communicate what you’d like in a positive way
• Learning nonsexual touching techniques
• Increasing or enhancing sexual stimulation
• Minimizing pain during intercourse

Sex therapy can be a scary step to take.  The very name makes it sound like something is really wrong, and couples often imagine the process being long and painful.  The fact is that many couples seek help with sexual issues they can’t resolve themselves. When they work smarter, not harder in a fun, relaxed atmosphere progress comes quickly.

Sex is a critical tool in building life long healthy relationships. Both partners should feel proud of their sexuality and about sharing it with their partner. The focus for a healthy sexual partnership is on sex that is mutually satisfying, esteem building, and pleasurable. But sex is a complex system of biological, social,  psychological, and relationship issues.  Sex (human sex anyway) is far from “natural.”  A breakdown in any one of these can cause problems such as:

• anxiety about sexual performance
• problems achieving orgasm
• settling for bad sex
• problems maintaining an erection
• painful intercourse
• problems with libido differences for the couples
• arguments about physical affection versus sexual libido
• recovering sexual desire after an affair
• understanding and addressing problem pornography use
• compulsive online sexual behaviors such as sexting / video chat
• stopping compulsive affairs
• recovering that “spark” for a couple
• sexual performance problems during infertility treatment
• sexless marriages
• low libido or sexual desire disorders

Before medication treatments, it was well understood that there is a strong psychological component with researched methods of helping couple overcome, not just cope with these issues.  Medications today are a strong tool that I often recommend; however, I find that most often couples report long standing issues with satisfaction, anxiety, frustration and rejection that need to be addressed as well.  Whether or not the issue is “medical” (i.e., hormonal, cardiovascular, neurological, etc.) the anxiety and pressure around the situation can become a social/ psychological/ relationship problem of its own.  Short-term, time-limited therapy can help the couple change how they approach sex, change rigid beliefs about themselves and sex, and create a sense of being an intimate partnership.

What will sex therapy look like? 

I use the COMMIT model of increasing interventions. Once the couple report that their problem has been resolved we stop with the least intrusive level needed to achieve their goals. The point of the model isn’t to limit or restrict the couple, but to ensure that I as the therapist don’t go where I’m not invited or needed by the couple. Sex is incredibly personal and I don’t feel that even as a therapist I need to be any more involved than the couple tells me.

C stands for Communication. As the therapist, I will be using language that is fairly clinical in nature – couples are encouraged to mutually develop their own language around sex and sexuality. Language has connotations that turn us ‘off’ or ‘on.’ Having had different backgrounds sexually, we may not even be consciously aware of how our partner’s language affects us. In this intervention level couples talk about different facets of sex and sexuality that they they learned throughout their lifetime. Sometimes just making language around a difficult topic helps couples understand each other better. Sometimes that communication has gotten angry and blaming.  I help couples learn to stop blaming each other and start working as a team.

O stands for Options. We discuss the breadth of sexual behavior in the human experience across the lifespan. I may help them to understand what are Green (always welcome), Yellow (ask or introduce the idea first) and Red light (rarely OK, but can be fantasized about) sexual behaviors for the couple. We discuss a broad understanding of sex and sexuality that goes beyond limited medical “frequency and duration” speech and incorporates intellectual, emotional and at times even spiritual understanding of sex. Sometimes just knowing what’s normal and healthy for a couple is enough to relieve shame and frustration and hence, solve the problem.

M stands for Managing Boundaries. Just like good fences make good neighbors, good boundaries make good lovers. Sexual intimacy and passion involves balances of presence and fantasy, closeness and distance, individuality and togetherness, dependence and independence.  We explore what boundaries need to be managed internally and which we share with our partners. We talk about asking, learning, and respecting boundaries as a healthy part of sexual relationships.  Couples learn to be assertive with needs in the face of boundaries.

M stands for Myths – Here we talk about how the couple thinks about sex. We know there are common myths about sex that are prevalent in western society, and by this stage I usually have a pretty good idea of what myths need to be addressed. Myths often arise from misunderstanding paradoxes (two seemingly opposite truths) within relationships and sex. Learning to understand both/and thinking versus either/or thinking is critical. Usually this is the level at which couples start to put all the lessons from the previous levels together and typically solve their own problems. If that is the case, then we stop here.

I stands for Instruction. If the couple haven’t yet solved their own problem this is the first place where as the therapist I’m giving direct instruction to the couple. No one will ever be asked to do things they do not want to do or are not ready for.  I’m a strong believer that one can’t give a healthy and partner-satisfying “Yes” if there isn’t the possibility to say “No.”  The point of instruction is to explore thinking and feeling created by the exercises. These exercises are designed to see what can be learned about each other. Sometimes the point is to reduce anxiety. At other times the point is connect with the partner. Other times the point is to self reflect on what it was like to share that experience with their partner.

T stands for Therapy. At this level we will most likely be talking about sexual traumas, shame narratives, and sexual fantasies. This is very difficult work, but for those couples that work through it (when needed) they report that it brings the couple closer in ways they never imagined.

Using this COMMIT model lets couples set the pace and depth of therapy at levels they are comfortable with. While this sounds like a clear linear format, it isn’t always so straight forward. Some couples take breaks between each level and return to therapy later for more work. Some couples loop back around to previous levels as they become aware of new thoughts or feelings about sex. Some couples have already done some work on their own and can skip through some levels very quickly.

If sexual performance issues, painful sex, sexless marriages, or lack luster sexual engagement is an issue for you, call today.