What Is Sex Therapy?

Qualified sex therapists are psychotherapists and relationship therapists who work with individuals or couples, and have advanced training and maintain continuing education in human sexuality. It’s the advanced training that really distinguishes them. Their training and their supervised experience with clients far exceeds that of other therapists. Sex therapy, compared to other forms of counseling, offers the most extensive, in-depth approach to all kinds of sexual and relationship concerns. Although some sex therapists may specialize in different areas or have particular skills in an area, all of us are trained generally to handle a variety of issues and work with clients who have a range of problems. So I’m going to run down a partial list of the kinds of issues that sex therapists are trained to deal with and that people come to see us about.

Reduced desire for sex, or no desire for sex is a very common one; difficulty becoming become aroused; erectile problems; orgasm problems; communicating about sex with partners; improving boring or routine sex lives; sexless marriages, you’ve heard a lot about that in the news of late, and we see quite a few people who identify that way; partners with different degrees or types of sexual desire or preferences; concerns about what turns you on, or who turns you on; being sexual with a partner if you have a history of trauma sexual abuse, or if your partner does; if you feel any pain during sex; out of control or compulsive sexual behavior; problems with body image that affect your ability to be sexual, or that affect any aspect of your life; trouble experiencing pleasure; sexual pleasure when there are physical challenges present or chronic illness is present; concerns about your sexual orientation or preference; helping parents communicate with their kids about sex is something a sex therapist can help you do. And of course, gender transitions, alternative relationships and alternative sexual practices.

The term sex therapy often confuses people, though, because it sounds like the work might be a little bit more narrow than it actually is. Even some mental health professionals have the mistaken notion that sex therapy only focuses on the functions or dysfunctions of sex – getting and keeping an erection, or having an orgasm. But that’s just not the case. Our sexual experiences and the way we express ourself sexually is very complicated, and this occurs within the great big context of our great big lives and relationships. So having healthy, satisfying sex is connected to everything about us. It’s connected to the culture we grew up in, it’s connected to the culture we live in now. It’s connected to our early sexual experiences and to the way we learned about sex in our families. It’s connected to how we feel about our bodies, to our physical health, to our moods and especially to the nitty-gritty of our most intimate relationships. All of these intertwine and they will affect the way we experience pleasure, and maybe affecting the sexual concern you’re having right now. A sex therapist has to be expert in working with all of these pieces of the puzzle of your life. It’s a very broad and comprehensive field. In fact, sex therapy is really the only field that bridges and brings together the work of ALL the other fields that touch upon psychology and sexuality – from the medical to the emotional to the sociological and socio-cultural.

As a potential consumer of therapy services, you need to know that in the US and in most other countries there is no licensing of sex therapy. With the exception of the state in Florida, no state in the U.S. licenses sex therapists. So theoretically, anybody can call themselves a sex therapist – you can call yourself a sex therapist. So you want to be careful in choosing a sex therapist, that you choose someone who is genuinely qualified, because using the term alone doesn’t ensure the level of education or training.

So, how do you know if someone is qualified? Well, you can certainly ask them a lot of questions and review their background on a case by case basis. OR you can choose someone who is already certified, who has already gone through the rigorous testing and training required to meet the standards of the premier certifying body for sexuality therapists. And there’s only one organization that does that – that is the American Association of Sexuality Educators, Counselors, and Therapists, or AASECT. AASECT is the premier credentialing body for sexual health professionals in North America. AASECT is also expanding globally, and has certified people all over the world, including Canada, Australia and the Far East.

Many people support AASECT’s work as members. But being a member is different from being certified. All of AASECT’s members benefit from sharing professional expertise, research, and educational opportunities. However, not all AASECT members are certified therapists, or certified educators or counselors, because certification is a demanding process. You can find certified sex therapists on the AASECT website at AASECT.org.

AASECT, as I said, also certifies counselors and educators. So let me explain a little bit about the difference between a sex therapist, a counselor, and an educator. The best way to think of it is in terms of depth. Educators give information but they don’t advise on emotional issues. They don’t go that deep. You’ll find certified educators in schools, you’ll find them in Planned Parenthood, you’ll find them doing workshops and seminars, you’ll find them writing about sex.

Counselors are qualified to provide both information and to give suggestions for change, but they’re not trained to do intensive therapy. So a visit with a certified counselor might focus on new techniques for sexual exploration, or, sometimes medical professionals become certified counselors, and they may offer a prescription for, say, an erection-enhancing drug, and at the same time advise you about how to sensitively bring it home and introduce changes into a relationship. Therapists – certified sex therapists – go the deepest in terms of exploring the emotional and historical and psychological aspects of sexuality. Therapists can do everything that educators and counselors can do, of course, as well – except prescribe medication if they aren’t medical professionals. Counseling, as compared with therapy, is often short-term and situation specific. Therapy can be short-term or it can be long-term. Sometimes sexuality educators and counselors prefer to call themselves “sex coaches,” especially when they work with clients in a clinical setting. Whether someone is an educator, a counselor or a therapist, AASECT certification is an important barometer of training and skill.

You may have read elsewhere that the best person to ask about a sexual problem or a sexual concern is your family doctor. I wish I could say that that is a good idea, but generally speaking, physicians are not the best people to be asking sexuality advice from. Even gynecologists and urologists very often are untrained in sexual medicine or in human sexuality in depth. They know the parts, but the fact is the medical schools don’t train doctors in sexual medicine or in the comprehensive and very necessary knowledge about human sexuality that they would need to answer the kinds of questions that you might be bringing to them. Now some doctors do get additional training – they go to workshops, seminars, take courses, and they do become expert sexual medicine practitioners. But one of the only ways to find out if that is the case with your doctor is to ask, and be very blunt about asking what their training in sexual medicine is. Or you can ask a sex therapist for a referral to a physician if you think that there may be something physical that needs to be addressed, because sex therapists always work very closely with medical practitioners in their practices.

Here’s what you want to consider when selecting a sex therapist:

  • First, she or he must be a skilled therapist – which usually means a psychologist, a clinical social work, or marriage and family therapist who has been licensed by a state to practice therapy.
  • Second, she should be certified by AASECT as a sex therapist or be able to demonstrate to you that her background is equivalent. Standards for AASECT certification are available on the AASECT website.
  • Third, she must be somebody that you feel comfortable talking with. You’ll be speaking explicitly about your sexual habits and behaviors so you should feel accepted no matter how unusual even you think that your sexual desires may be. You should feel, above all, that your therapist “gets” you. And if there are special circumstances in your life – for example, if your religious, your ethnic, or your cultural background in any way impedes or you feel it impedes or strongly influences your sexuality, you want to ask the therapist whether she has experience working with people who come from similar backgrounds.
  • Finally, although it should be pretty obvious by everything I’ve said so far, sex therapy, you need to know, does not include any kind of sexual contact. Nor would a legitimate sex therapist ask you to perform any kind of explicit sexual act with your partner during the therapy.

Above all, though, you want to remember that sex therapy is a real relationship between you, or you and your partner, and the therapist. That means that feeling safe, feeling comfortable, and feeling as though you can share yourself freely is the utmost important aspect. If somebody has great credentials and they look perfect on paper, but your gut tells you this isn’t the right person for you, then probably, this isn’t the right person for you. So always trust your gut.

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