What is sex therapy and who is it for?
The term "sex therapy" can conjure up all kinds of images, many of which may be inaccurate. Sex therapy is simply the process of bringing issues of sexuality into therapeutic work so that these issues can be talked about, understood, and when necessary transformed into experiences, attitudes and practices that are in more line with your desires, needs and values.
Common concerns that clients seek support for include worries about having overly high or low levels of desire, difficulties with sexual arousal, disparities in sexual desire between partners, difficulty reaching orgasm, self-judgment or shame around sex and sexual fantasies, reduced sexual pleasure, the presence of pain or discomfort during sex, and the use of pornography or engagement in specific fetishes. Sex therapy may also overlap with broader life issues, such as sexual orientation, the challenges of coming out, or the impact of a history of sexual abuse on current experiences of intimacy.
As a client, you may participate in sex therapy individually or with your partner and depending on what you are looking for help with your therapist may have opinions about which arrangement may be more helpful. Many couples who are struggling in areas of their relationship unrelated to sex may also experience tension or concerns about their sexual relationship, and sexual challenges can also lead to conflict and relationship insecurity, even if other aspects of the relationship are strong.
We are all sexual beings
While expressions of sexuality are becoming increasingly explicit in the media and online, it can still be difficult to have frank conversations about sex, or to find room to explore experiences of sexuality that don't conform to what is portrayed in the media. There can be a lot of shame and insecurity about sexuality, fears of being too sexual, not sexual enough, or not sexual in the "right" ways. We are all sexual beings - even persons who identify as asexual and who do not engage in sex with others are still influenced by existing cultural norms and expectations, and in turn may have concerns around aspects of their sexual identities that can be helpful to explore with a therapist.
Although clients often attend sex therapy because of problems, some clients may seek therapy to simply understand more about their sexuality, get help articulating desires and asking partners for sexual experiences that are more fulfilling, or to figure out how to express aspects of their sexuality in safe and ethical ways.
What if I want help but I'm too embarrassed?
No therapist should ever pressure you to talk about something that you are unwilling to talk about unless someone's safety is on the line. If you are too embarrassed or afraid to talk about sex, or any other part of your life, you are always within your rights to say "No". For some people learning to say "No" clearly is therapeutic in and of itself. However, it may be hard for the therapist to help you if you are not willing to talk about parts of your life that are connected with your concerns. Most people feel a little shy or hesitant when first coming to therapy, and that is understandable. It may take some time to know that it is safe to bare your heart to another person with whom you have just met. Just like any other relationship, shyness and embarrassment often lessen with time as trust builds.
Therapy needs to feel emotionally safe so that we can encounter the parts of our experience that don't - without falling back into unhelpful old habits. In order to grow and evolve as human beings we need to have new experiences and step a little outside of our comfort zones. Encountering our growing edge can sometimes be uncomfortable, but it is also when we feel most alive. Stepping out too far or too quickly, however, may not be helpful and may lead us to shut down and withdraw. We all experience fear and embarrassment and good therapists are acutely aware of, and sensitive to, this process. I would encourage you to be honest with your therapist about your fears and concerns and work together to figure out how to proceed in a way that feels safe and non-shaming, while still working toward your goals.
Nat Roman is a Registered Psychotherapist with a Master of Science in Couple and Family Therapy and a BA in Psychology and additional specialized training in Nonviolent Communication (NVC) processes, community based restorative conflict circles, and fifteen plus years studying, practicing and teaching mindfulness meditation practices and Buddhist psychology. In an earlier stage of life Nat worked as a professional musician and strongly believes that creativity is an essential part of life, whether one is engaged in a formal creative discipline, problem solving, or attempting to get kids off to school in the morning.