Feeling ambivalent about sex therapy? 

When a couple comes in for sex therapy, I can feel their combined energy of eagerness and hesitation. On the one hand, you’ve finally decided to get help for a sexual concern. You did your research to find a qualified therapist, scheduled the appointment, and have arrived at your first session.

Time to find solutions, right?

On the other hand, your sex life is often a private topic. You’re meeting with a stranger. You’re about to talk about deeply personal issues. “Putting it all out there” can feel uncomfortable, risky, and difficult. You may not want to hurt your partner’s feelings or perhaps you don’t want to be seen as “the problem” partner. 

In the early stages of sex therapy, I like to focus on building a relationship with the couple and with each partner individually. Sure, I ask questions about your sex life, but I also step beyond that to learn about you as a whole person. Our conversations touch on a wide variety of life experiences, not just sex.

Why? Sex doesn’t sit in a vacuum by itself. Many of your life experiences influence your sexual expression or lack of expression. All of your life domains intersect and influence each other.

What Do We Talk About First?

Within the first four or five sessions, we typically cover an overview of your current relationship story, including a full relationship history to help clarify how you’ve arrived at where you are today. 

We also talk about your career, parenting (if applicable), your medical history, mental health struggles, stress management and how you handle your emotions, the family you grew up with, physical health, traumas, losses, adjustments, and of course, your sex life. 

The Early Sessions

When we focus on your sex life, we’ll explore the quality and frequency of sex, any dysfunctions, anxieties, worries or pain associated with sex, along with your history of sexual desire, arousal, and pleasure. We’ll explore when in life you feel most relaxed and how you feel when you take time to focus on your body. 

Some of this conversation happens within a couples therapy format. I also schedule a few individual sessions with each person to help me connect with each partner separately and apart from the context of the relationship. 

Ultimately, while one partner may become the designated “patient”, the relationship as a whole is my client. Any suggestions or feedback that I offer, even when it’s directed toward one partner or the other, is in support of creating a healthy, vibrant relationship. 

Laying the Groundwork for Deeper Conversations

While you may want to jump right in to find quick solutions to your problems, sex therapy doesn’t typically unfold that way. 

According to John Gottman, Ph.D., couples will sit with their problem for an average of five years before they decide to reach out for help through couples therapy. While I don’t have the research on how long it takes couples to reach out specifically for sex therapy, I imagine it would be even longer due to the sensitivity of the topic. 

Since the problems don’t typically just arrive overnight but build over time, the process of healing or finding resolve takes at least 10 sessions to feel a shift. Even if a breakthrough happens quickly, sustaining sexual health and wellness takes time and repeated practice.

Creating the Right Pace

Since most couples experience both an eagerness and a hesitation to resolve their sexual issues, the pace of the work matters. Move too fast, and it will overwhelm you. Move too slowly, and you’ll feel like you’re not making progress. A good, productive sex therapy experience requires us to find the sweet spot that generates progress but also feels manageable. 

Important Questions in Sex Therapy

Early on, I love to explore what may seem like “basic” questions/answers about sex with couples. These questions often give couples pause because they’re the types of questions most folks don’t really think about when it comes to sex.

The first question is: What is sex?

Seems obvious, I know. But seriously, when you say, “We had sex” or “We’re not having sex,” what exactly are you referring to? Think about how you might answer that question before reading further.

Most heterosexual, cisgender couples say that sex is intercourse. 

Then I ask, does that include orgasm?

Most people say yes.

Then I ask, for both partners? One partner? If the other partner didn’t orgasm during intercourse, did sex happen?

Now the conversation gets more interesting. The pause and the uncertainty set in. 

These questions open up an interesting conversation about sex, how you define it, what qualifies as sex, and how that definition shapes your sexual desire and experience.

My Favorite Follow-Up Question in Sex Therapy

After we explore what sex is, how each partner defines it, and consider how their definitions influence each partner’s desire for sex, we then deepen the conversation. 

My follow-up question is: Why do you have sex? 

Again, this may seem obvious, but I guarantee that most people have never actually thought about it. Most partners default into the action of having sex (according to their definition) without considering why they do it. 

Some answers might include: 

• Because it feels good
• For closeness
• For a release
• Because I’m supposed to

Why do people, in general, have sex?

Then we look beyond the couple’s reason, and I’ll ask: Why do people, in general, have sex? What are the many reasons someone might have sex?

Some couples will list the very same reasons as their own and not move beyond that. In that case, I help them out by offering some ideas. Other couples may add reasons for having sex that go beyond their own motives.

Some of these can include:

• Stress relief
• For fun
• To feel powerful
• To feel desired

I might add some additional ideas, such as:

• For revenge
• To feel loved
• To feel attractive
• For spiritual enlightenment
• For money
• To feel valuable
• To manipulate
• For comfort
• Out of boredom

This exercise helps couples learn and understand that sex with another person is a complex experience. It has many sides, outcomes, and functions. One partner’s definition of sex may not match the other’s. One partner’s “why” may be different from their beloved’s. 

When Your Sexual Motives Differ

If one partner uses sex as a stress release, but the other partner uses sex to feel connected, the mismatched energy and motive is felt. The partner who uses sex as a stress release may not be very focused on making the kind of connection their partner wants. This difference can shut sex down completely in a relationship.

In sex therapy, the solution is not a matter of finding a way to “just do it”. Sex is an existential experience. Meaning-making is an important part of the work to help create healthy, consensual sexual expression and engagement. 

Setting the Stage for Deeper Work

These preliminary conversations create a backdrop for you to explore your own motives, values, and reasons for wanting or not wanting sex. 

It creates the foundation to address longstanding concerns such as sexual desire differences, sex after having a baby, sex after a diagnosis, performance issues, or sexual pain.

As sex therapy unfolds over several weeks, I’ll often refer back to your “what” and “why”. These ideas may evolve as therapy progresses, with their “what” and “why” changing.

Your sex life is not a static experience.  It’s dynamic and changes over the relationship lifespan. That means that your “what,” and your “why” needs to have some flexibility to support change, as well as room to grow. 

In Summary

These seemingly “basic” conversations create a gentle entry into the private lives of a couple’s sex life. It helps establish a safe environment to explore the complex and nuanced topic of sex. 

The work focuses on a combination of therapeutic conversations, sexual re-education, sexual communication practices, healing of erotic wounds, and exercises for home practice. This combination focuses specifically on the couple’s unique goals. 

Over time, the hesitation that once accompanied the eagerness lessens as the couple begins to develop a richer understanding of their sexual selves and their sexual relationship. 

They typically gain confidence in themselves as sexual beings and clarity in their sexual and relational needs. They strengthen sexual communication and find a way to honor each other and the relationship as a whole. 

 

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