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
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
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 Does One 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 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 Does One 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
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.