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  • Natasha J. Thomas, MD

Sex Therapy: It's Not as Weird as You Think

I had been caring for a patient for 4 years when she learned I had recently become a sex therapist. I remember when I told her, she grew silent – and staring at me, I could see the wheels turning. In her eyes were fifty questions she’d always wanted to ask someone about sex and intimacy but never had the comfortable opportunity. She took a big, deep breath and sighed. It was relief. Finally, she was going to get her questions answered in a safe space.

I became a sex therapist after I noticed a pattern. Whenever I would need to inquire about a patient's sexual health, they would stop short of answering and look at me like, “this woman is strange.” I’d try to casually sit there like what I’d said was no big deal. And eventually, they would begin to answer. After a while, they’d start throwing out questions about their sexual health left and right. It seemed they were happy to share once they realized they had permission. Sometimes, just out of curiosity, I’d ask if any doctor had ever asked the same questions. I received a chorus of no’s. So, I decided to learn how to ask about and treat sexual concerns the right way.

And even though many of my patients expressed feeling comfortable talking about “anything” in my office, once I became a sex therapist, I saw a distinct shift. Women were able to tell me their true feelings about physical intimacy, and how it related to their work and family responsibilities, desire to achieve or avoid pregnancy, communication with their spouse and messages about sex from childhood. Men shared how stress to “perform,” both at work and in the bedroom, was at times exhausting, discouraging or even infuriating. And both groups were struggling with hormonal fluctuations, body image concerns, sexual desire differences, feelings of rejection or pressure, and relationship frustration.

In sex therapy, you get to sift through all these issues – and more. Your therapist will help you talk through concerns, may suggest reading or other resources, and will likely assign homework. You can see a sex therapist as part of a couple or as an individual. Either way is ok! And just a word to the wise - sex therapy should not include any sort of sexual involvement with your therapist or observation of your sexual behavior with your partner in session. That is more consistent with a practice called sex surrogacy.

So What Do You DO In Sex Therapy?!

When patients/clients see me for sex therapy, I begin by introducing myself and invite them in for a seat. Once everyone is settled, I “frame” the session – which is explaining the definition of sex therapy, reassuring patients about their confidentiality, and discussing the length of sessions, rules of the sessions and goals. Then, I ask why they have come in and I follow-up with questions.

Couples’ work is different in some important ways from individual sex therapy. I usually ask about general mental and physical health, prescription medications and sexual history (previous experiences, history of sexual trauma, earliest teaching on sexuality, history of STDs, number of partners, etc.). However, if I’m meeting a couple for the first time, I do not ask sexual history in front of a person’s partner. Instead, I invite both people back for individual sessions and we delve into those questions then. In those sessions, I will also ask what a person’s pet peeves and preferences are about their partner and his/her sexual behavior and approaches.

I do ask quite a few questions about the sexual habits of the couple when both members are present. Sex therapists need to know what your patterns are - including who normally initiates physical contact, what are typical preferences, frequency (desired and realistic) and more.

Individual sessions are just as helpful. Often, people can address concerns about topics such as low desire for sexual activity, "performance anxiety", erectile dysfunction, inability to experience orgasm and even pain during intercourse. A sex therapist's role is not to judge your lifestyle. As long as your activities only involve consenting adults and don't contribute to destructive practices, therapists will be willing to help you reach your goals.

This all may sound kind of intense but it really is not. Regularly, clients end the session laughing! Getting the tension out of the room with honesty reveals the best in people. And once people are in a lighter space, I assign homework. Homework, and sex therapy in general, is more about you knowing yourself than about controlling or influencing a partner.

Why Bother?

Because it works!

Curious what one type of homework may be? Here's one for couples. The pioneers of modern sex therapy, William Masters and Virginia Johnson, developed an approach called Sensate Focus (focus on sensation) in 1970. Their approach removed the goal of intercourse, instead teaching a couple to focus on the large range of pleasurable sensations that could be elicited by touch (even non-sexual touch). In sex therapy, you may be assigned to spend two hours per week practicing Sensate Focus exercises, starting with something like mastering how to caress your partners hands, feet or face. Exercises are progressive and will advance with time. At no time should your therapist proposition you for sexual interaction.

All in all, sex is important to us. It is a gift in our relationships. It is one way we receive our children. It makes us feel loved and accepted. And for many, it is very closely linked to mental health – having been studied to improve mood, alleviate anxiety, boost self-esteem and foster emotional closeness, a factor that prolongs life. In America, 1 in 5 marriages is "sexless" – with 10 or less encounters per year. That’s not necessarily a sad or bad thing, if both partners are cool with it. But the problem is, many people aren't cool with it at all.

There are people who can help you feel more comfortable with your sexuality, sexual behaviors, responses and the overall concept of intimacy. Reach out to someone today! If you find the right therapist you will be so glad you did.

Please email me if I can point you in the direction of a great therapist or other resources.

In the meantime, try to connect with the American Association of Sexuality Educators, Counselors and Therapists (AASECT) here.


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