Sex therapy is simply therapy that specifically addresses sexual problems. A sex therapist can be considered a specialist in the general field of therapy in the same way that a urologist is considered a specialist in the general field of medicine. Though the practice of sex therapy varies widely, most of these specialists have the following in common.
Sex therapy is typically a short term (6 to 15 weeks) solution focused intervention. Solution focused means that there are concrete goals with which to gauge progress, that there is a conscious utilization of client’s strengths, and that homework assignments are utilized to encourage active steps toward one’s goals.
While more general relationship issues are an integral part of sex therapy, they are not the primary issue. Sex therapists treat the sexual problem directly as opposed to assuming that if a couple resolves their other relationship issues, their sexual functioning will eventually improve. Since relationship issues are an integral part of sex therapy, and often one of the dynamics that perpetuates the sexual problem, couples who meet their goals in sex therapy invariably improve functioning in other areas of their relationship as well. When relationship issues are the primary problem (difficulty negotiating conflict, difficulty negotiating value systems, difference in attachment styles, etc.), then more traditional couples therapy is more appropriate.
Sex therapy is a process grounded in the science of sexuality, called sexology, not in the ideology or morality of our culture. Our world is filled with judgments about what sexual behavior is “normal” or acceptable. As long as nobody’s basic rights are being violated, a sex therapist strives to be nonjudgmental, with the intent of helping a couple meet their goals from within their own value system. A sex therapist can provide information about what behaviors are statistically common and uncommon, and can help a client explore their own value system, but cannot decide for the client what behaviors are morally acceptable.
One of the assumptions of sex therapy is that physical intimacy is a natural process and drive for couples. If there’s a problem with how this drive plays out in the relationship, it’s further assumed that “roadblocks” have developed that are impeding the couple’s natural process. The role of sex therapy is to identify and assist with the resolution or management of these roadblocks such that the couple is free to do what comes naturally. Common (and simplified) examples of roadblocks include anxiety related to sexuality, feelings of rejection, or other emotions that impede a man or woman’s ability to be intimate. Specific medical problems can lead to the formation of roadblocks if a couple is not able to adjust to changes in sexuality that accompany the medical problem. Difficulty with sexual communication is probably the most common roadblock, but one that couples overcome regularly in sex therapy.
Sex therapy is talk therapy. There is no sexual touching during sessions. Typically there will be assignments given that will expose a couple’s roadblocks and provide an opportunity for resolution. Since the experiential part of improving one’s sex life always happens outside of sessions, it’s critical that couples are able to complete the exercises. Though sex therapy is typically a very successful intervention, consistently not completing homework assignments is the number one cause of treatment failure.
Sex therapy is almost always done in the context of a couple’s relationship, with both partners involved in the therapeutic process. One of the sayings in sex therapy is that “it doesn’t matter who brought the problem to the relationship, the solution always lies with the couple.” It’s also invariably the case that both partners have a role in maintaining whatever roadblock exists, and thus it’s important that both partners be an active part of the solution. In certain situations it’s appropriate to do sex therapy in the context of seeing an individual; this is the case if someone does not have a partner, or if a person’s struggle with their own sexuality is significant enough that they need to get some resolution personally before they can be available to their partner. In any case, a sex therapist can help the client identify the setting that’s likely to be most beneficial.