An Introduction to Sex Therapy

What is sex therapy?

Sex Therapy is a professional and ethical treatment approach to problems of sexual function and expression. It reflects the recognition that sexuality is of legitimate concern to professionals and that it is the right of individuals to expert assistance with their sexual difficulties. Sex therapy, then, is the focusing of specialized clinical skills on helping men and women as individuals and/or as couples to deal more effectively with their sexual expression.

Why is sex therapy necessary?

Sex therapy is the result of relatively recent scientific attention to human sexual function and dysfunction. Out of the increased knowledge of the physiology and psychology of human sexual behavior has come a new professional appreciation for human sexual response. At a time in our society when sexuality is being more openly discussed, we are beginning to realize how uninformed many people really are about this important personal topic.

The importance of sexual function for individuals varies, of course, but for many it is closely tied in with their total concept of self identity. For these, problems in sexual function may lead to devaluation of self - "When I cannot feel good about my sexuality, how can I feel good about myself?" We are also in a time when marital and family units seem to be quite vulnerable. Concepts of these traditional relationships are being reevaluated, challenged and restructured. Alternatives to marriage are now being more openly tried and are becoming more widely accepted than at any other time in our history. Regardless of the structure of the intimate relationship shared, sexuality serves a valuable function for most couples. It becomes an expression of caring, not only for the partner, but for oneself. It can become a powerful bonding element in a relationship, which, in today's society, must withstand considerable demands on time, energy and commitment. Dissatisfaction with the sexual relationship and the loss of that shared intimacy, in many instances, may lead to negative feelings and attitudes which are destructive to the relationship. Many marriages end therefore, because of unresolved sexual differences and difficulties.

Who goes for sex therapy?

The sex therapist works with a wide variety of problems related to sexuality. People seek help with such problems with arousal (impotence and frigidity), as well as problems with orgasm (either inability to climax or the inability to control ejaculation). In addition to seeking medical evaluation and treatment, many people who experience painful intercourse also seek the assistance of a sex therapist. Couples often seek help when it becomes apparent that differences exist in their sexual desires or when they sense that their sexual relationship is not growing as they would wish. The need for additional information, more effective verbal/physical communication, and for sexual enrichment lead many couples to the sex therapist's office in their quest to enhance their intimate relationship.

The qualified sex therapist is also available to those wishing to resolve troublesome sexual inhibitions or change undesirable sexual habits. People with questions about their sexual identity or sexual preferences seek out the trained sex therapist for consultation. Parents consult the therapist about the sexual curiosity and experimentation of their children and seek insight into ways to foster the healthy development of their youngsters through effective sexual education in the home. Sex therapists also assist those experiencing sexual difficulties as a result of physical disabilities or as the consequence of illness, surgery, aging or alcohol abuse.

How does sex therapy differ from other therapies?

Sex therapy employs many of the same basic principles as the other therapeutic modalities, but is unique in that it is an approach developed specifically for the treatment of sexual problems. That is, sex therapy is a specialized form of treatment used with one aspect of the wide range of human problems. Herein lies its value and also its limitation! Sex therapy techniques, when applied by an unskilled counselor or therapist, might focus too readily on mechanical sexual behavior, to the exclusion of the total individual and the total relationship.

Are there limitations?

As with any therapy for personal or behavioral difficulties, sex therapy has its limitations. Although usually brief and effective with most sexual concerns, sex therapy does not offer a miracle cure for all interpersonal problems.

Success of treatment depends upon many factors, not the least of which are the nature of the problem, the motivation of the patient, the therapeutic goals and the therapist's skills. The motivated prospective patient and/or couple should choose a therapist carefully and establish realistic goals early in the counseling.

If you are not comfortable with your therapist or feel that the therapist has set unrealistic performance goals for you, discuss these concerns with him/her. All therapy depends upon trust and mutual respect, but this is particularly true when working with intimate issues of sexuality.

How do you know if a sex therapist is qualified?

One must realize that with any new field, a variety of definitions and expectations will exist for a time, and that a wide variety of people will claim expertise in accordance with their own definition of the field. The expectations presented here might be criticized by some as too rigid, but it is purposefully intended to present a fairly strict set of guidelines for selecting a sex therapist. Very few states license sex therapists, so the client must exercise caution and must choose wisely!

Five criteria need to be met in choosing a sex therapist. First of all, the therapist must have a sound knowledge of the anatomical and physiological bases of the sexual response. The sex therapist may, therefore, have a basic medical background or may come out of another non-medical profession but with post-graduate education in the biological aspects of human sexuality. A qualified non-medical sex therapist will usually work closely with physicians or may function as a non-physician in a medical clinic or university school of medicine.

Secondly, the qualified sex therapist must be skilled in providing counseling and psychotherapy, and most sex therapists will be found to have a sound background in psychology, psychiatry, psychiatric social work or psychiatric nursing. This background in the behavior sciences is essential to the understanding of the total individual and to the planning of an individualized treatment program. There are, however, some notable exceptions to the rule that a sex therapist should have a traditional mental health training background, in that there are also highly respected and well-trained sex therapists who began as clergy. These clergy, however, need to demonstrate specific post-graduate training in pastoral counseling or in equivalent psychiatric mental health areas.

The third criterion is that the sex therapist, having both biological and psychological sophistication, must be able to demonstrate extensive post-graduate training specifically within the areas of sexual function and dysfunction, sex counseling, and sex therapy. A weekend workshop or possession of a few sex therapy films does not meet this criterion, and the prospective client should feel free to ask for a list of specific training experiences in these specialized areas.

The fourth requirement to be met is that of having expertise in relationship counseling. That is, the sex therapist should also be a skilled marital, family and/or group therapist. In order to work effectively with sexual problems, the sex therapist must be able to work effectively with non-sexual relationships as well. Sexual behavior does not occur in a vacuum - it occurs within a relationship! The total relationship must, therefore, be accurately evaluated and treated.

The fifth requirement is the therapist's adherence to a strict code of ethics! Prospective clients have the right to request a copy of the therapist's ethical code before agreeing to any treatment.

How do you find a qualified sex therapist?

Most qualified sex therapists do not depend on ads in the newspaper, as most professionals have made themselves and their credentials known to other professionals in the community. If you need a sex therapist, you might begin by consulting your family physician, gynecologist or urologist. Ask for a referral to someone your doctor has used confidently in the past. In addition to this, you might be inclined to ask a trusted clergyman for a referral. As you begin to collect information about available resources, you might then wish to turn to the telephone directory Yellow Pages, looking under such headings as "Psychologist," "Social Workers," "Marriage and Family Counselors," and elsewhere. Remember, there is probably no legislative control of the title "Sex Therapist" in your state, so simply finding the title in the phone book does not document that individual's clinical skills! In all states, however, licensing laws control who can list as a "Psychologist" or as a "Physician." A small number of states now also restrict the listings of "Social Workers" and/or "Marriage Counselors."

When calling a professional, be sure to ask questions about qualifications, experience and fees! It is recommended that you call and ask, "Do you have a specialty?" rather than stating, "I have a sex problem - can you help?"

Perhaps the most useful referrals will come from other knowledgeable professionals within your community. However, it is also helpful to be able to discover which therapists belong to recognized national professional associations having high membership requirements and enforcing rigid codes of ethics. Specifically, The American Association for Marriage and Family Therapy (AAMFT) is a national professional association which credentials marriage and family therapists and which would provide a list of its clinical members in your geographical area. More specifically, The American Association of Sex Educators, Counselors and Therapists (AASECT) is the largest national group which certifies sex educators, sex counselors and sex therapists. You can learn the names and addresses of the certified professionals in your area by writing to this association. AASECT will also provide you with a copy of their Code of Ethics for Sex Therapists upon request. Addresses for AAMFT and AASECT are provided at the end of this page.

What can I expect in sex therapy?

Even qualified sex therapists may differ widely in their basic approaches to the treatment of sexual problems, but some generalizations can be made.

First of all, you can expect to be talking explicitly and in detail about sex. One cannot solve sexual problems by talking around them! Neither can one gain new sexual information unless clear, direct instruction is given!

Second, you might expect to be offered the opportunity to add to your knowledge by reading selected books and/or viewing clinical films designed specifically for use in sex therapy. You should not, however, do anything which you do not understand, and you must reserve for yourself the right to question the purpose of an assignment. It is your right to decline or postpone acting on the suggestions of your therapist, rather than allowing yourself to be pushed into behavior which might actually increase your discomfort. Every assignment, task, or experience presented by the therapist should fit into an understandable and acceptable treatment plan - and you have the right to question the procedures.

Third, you should expect sex therapists to be non-judgmental and to portray their own comfort in giving and receiving sexual information. While you might expect to be challenged and confronted on important issues, you should also expect to experience a respectful attitude toward those values which you do not which to change.

Fourth, unless your therapist is a licensed physician wishing to conduct a physical examination, you should not expect to be asked to disrobe in the presence of your therapist. Sexual contact between client and therapist is considered unethical and is destructive to the therapeutic relationship. Neither should you expect to be required to perform sexually with your partner in the presence of your therapist. Overt sexual activities just should not occur in your therapist's presence, even though the talk, material and the assignments must, by the nature of the problem, be specifically sexual and at times bluntly explicit.

Finally, you should feel that you are heard and adequately represented in your sexual therapy. That is, you should that you have been stereotyped as "female," as "gay," as "too old," or in any other way that interferes with your sense of unique identity within the therapeutic setting. You should feel that you are being treated as an individual, not as a category!

Sex therapy is a new, dynamic approach to very real human problems. It is based on the assumptions that sex is good, that relationships should be meaningful, and that interpersonal intimacy is a desirable goal. Sex therapy is by its nature a very sensitive treatment modality and by necessity must include respect for the client's values. It must be nonjudgmental and non-sexist, with recognition of the equal rights of man and woman to full expression and enjoyment of healthy sexual relationships.

For more info:

American Association for Marriage and Family Therapy (AAMFT)
1100 17^th Street, N.W., 10^th Floor
Washington DC 20036-4601
Phone: 202.452.0109

American Association of Sex Educators, Counselors & Therapists (AASECT)
P.O. Box 5488
Richmond, VA 23220-0488
Phone: 804.644.3288
E-Mail: assect@worldnet.att.net
Web Site: http://www.aasect.org

American Academy of Clinical Sexologists (AACS)
1929 18^th Street, N.W., Suite 1166
Washington DC 20009
Phone: 202.462.2122

Last updated: 8/05

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