What Can I Expect from Sex Therapy?

When a couple is struggling in their sexual relationship and they finally decide to reach out for help, they often wonder what it will be like. The topic itself can feel so personal and loaded with so many intense emotions, that some get paralyzed with feelings of fear and anxiety, and never make it to my office from being so overwhelmed. Hopefully, I can remove some apprehension and help you understand what sex therapy is like.
 
Finding Words
Perhaps the first thing I do when I meet a couple for sex therapy is give them permission to talk about sex. While that may sound simplistic, it can be liberating for many…especially for those who grew up in families and churches where the topic was off limits. Some find that my office becomes a space where the unspeakable can be discussed openly and appropriately without the shackles of shame. Words can be found to articulate those feelings, behaviors and even parts of the body that in the past were classified as wrong or even dirty. Embarrassment is replaced with relief as we openly discuss the topic of sex and sexuality, discovering together the problems with all of the contributing parts…relational, physical, spiritual, emotional and psychological.
 
Discovering the Story
Once we have established some connection together and you are ready to move forward, I will ask you to complete some forms, so I can better understand and assess the sexual areas of concern. These forms are in addition to the couple intake that you complete prior to the first session, and may take some time to complete. In order to thoroughly understand the pieces of your story, once each spouse completes the forms, I will meet individually with each person for a session or more to discuss the provided information. People come for a variety of problems including low sexual desire, arousal issues for men and women, difficulty climaxing, and painful sex. The individual sessions offer relief from possibly offending one's spouse and give each person the freedom to openly explore and discuss any concerns they have and any information from the past that might be important for me to know. This assessment is very helpful in understanding some of the more complex issues contributing to the sexual problems.
 
Customizing Therapy
The therapy process is certainly not the same for everyone. Some couples come less frequently than others, while other couples need to meet more often and longer due to hurts in the marriage that complicate the sexual problems. Affairs often create insecurity and add a layer of anxiety that hinders sexual feelings. Some enter therapy with physical problems such as hormonal imbalances, and these will need to be addressed along with the emotional and psychological issues. Others have wounds from childhood sexual abuse that create strong reactions and aversions that must be treated. Whatever your sexual story is, we will create an approach that allows you to move toward healing at a pace that is good for you.
 
Working Together
While the process of therapy is unique with sexual issues, it is similar to what one might experience with most types of therapy. The problem will not be addressed in a linear focus…such as “he or she is the problem”; instead, we will partner together to gain understanding into the various factors that contribute to the sexual issue. This can include relational issues, past trauma, past sexual experiences, and physical issues. Sexual problems often create shame, and a couple may find themselves easily triggered by the topic. They argue and find themselves feeling helpless and discouraged. Many suffer alone and in silence. You can imagine the importance of addressing these relational issues as we also work on the sexual problems. The past trauma, childhood and church experiences, along with so many other factors, become part of the treatment plan.
 
Creating Safety
One of the most important parts of sex therapy is a sense of safety. Without the foundation of safety, we will not make much progress. Couples not only create safety with me, but more so, they have to establish this with one another. When vulnerable sharing is met with understanding and empathy, hearts start to feel safe. They start to believe, “if my heart is safe, then maybe my body will be safe too.” “I can allow myself to feel sexual feelings. I can allow myself to be connected to you.” “I can be honest with myself and with you about my emotions.” With safety established, we can move forward with sex education and with homework assignments that invite couples to communicate together and share new sexual experiences.
 
Rediscovering Sexual Connection
Many sexual problems are the result of anxiety and pressure. People feel pressure to feel aroused when they don't realize that both arousal and climax are both involuntary. The more you try, the more you are likely not to experience what you are desperately hoping for. It is like swimming toward a float in the water with such force that you simply push it further away from you. Information about sex offers insight into how God designed our bodies and the sexual experience. Sexual assignments are helpful because they remove pressure that hinders sexual feelings. They are carefully designed to be progressive with success being measured as noting noticeable differences. Couples agree to only do what is described in the assignment. Pleasure becomes the focus, not performance. Couples partner together for experiences without demand. They agree to increase their awareness of their senses…sight, sound, touch, taste, and smell. With pressure removed, they are free to be present in the moment, soaking in what they are experiencing. They can risk embracing pleasure and even move toward it. These assignments, coupled with times of processing as couples, as well as in therapy, allow the process to move forward toward the established goals.
 
Finishing Therapy
As a therapist, I have the pleasure of working myself out of a job, and I am thrilled when sexual issues are less problematic or fully resolved. When couples discover, or rediscover, sexual pleasure and connection, it is exciting to celebrate together. Where there was once stress and anxiety, now they find anticipation and excitement. You may be reading this and finding yourself described by the words above. I hope you will find help. Sexual struggles are some of the most painful and loneliest problems that couples will face. If I can help or if you have any questions, let me know.