What Really Happens During a Sex Therapy Appointment?

Date: March 1, 2017      Publication: Bottom Line Health      Source:  Barry McCarthy, PhD, American University      Print:

Admit it: You’re curious. When you hear the phrase “sex therapy,” you wonder who actually goes and why. What do people do in sex therapy? And could it help me?

It’s not as mysterious as it sounds. The point of sex therapy is to help partners or spouses—and sometimes singles not in committed relationships—regain an active and satisfying sex life. Sex therapy can be done individually, but it is more successful when done as a couple. 

An under-recognized problem: More people could benefit from this specialized therapy than actually seek it—sexual problems, including low libido, premature ejaculation and erectile dysfunction, are more prevalent in the US than the incidence of anxiety and depression combined.


When a couple’s sex life is going kaput, forgoing this valuable tool may endanger one’s relationship. That’s because couples—both heterosexual and homosexual—often underestimate the importance of a mutually pleasing sex life to their overall bond.

Important finding: A study cited in the Journal of Marital & Family Therapy reports that contented partners attribute only between 15% and 20% of their happiness to a pleasing sex life, while unhappy mates ascribe 50% to 70% of their distress to sexual problems.

In addition, one of the major causes of divorce in the first five years of marriage (whether it’s a first marriage or a second marriage) is sexual problems or dysfunction.

Here’s what sex therapy is all about and how it may help you…   


Back in the 1970s, the biggest issues centered on arousal and orgasm. Now the major problem is desire—or lack thereof.


Perhaps surprisingly, healthy long-marrieds tend to be more sexually satisfied than others, even though they might not have sex as often as they used to. The most vulnerable time for couples to stop being sexual—defined as having sex fewer than 10 times a year—is within the first few years of marriage, after heady romance fades and day-to-day drudgery sets in. Many spouses have trouble transitioning to a more humdrum existence where they view each other as life partners and intimate friends but begin to de-eroticize the other person.

Danger points: It’s during stress points such as childbirth or long-term infertility treatment when major sex problems, such as lack of desire, tend to spike. Other reasons people go to sex therapy include unwanted sexual fetishes, painful sex (resulting from a chronic medical condition, for example, such as arthritis) and/or poor body image (due to being overweight, for example, or a disfiguring operation). Sex therapy can also facilitate recovery for victims of sexual abuse and assault.


Nudity or sexual touching isn’t part of office-based therapy sessions. In the office, talk therapy is front and center, helping couples identify the anxiety, inhibitions and/or unrealistic expectations that interfere with their sexual pleasure.

A sex therapist will assure patients that they won’t be pressured, and explain that he/she needs to understand each partner’s psychological, relational and sexual strengths and vulnerabilities.

Homework: After each weekly or biweekly session—which, for most couples, continues for three months to a year—sex therapists assign partners homework. These exercises typically include talking, touching and setting up erotic scenarios. Examples: A woman might practice her ability to veto touch she doesn’t like and express her pleasure in touch she enjoys. A man might be given an exercise that involves the wax and wane of his erection. 


About half of sex therapy takes place in the couple’s home. If a couple has difficulty with an exercise at home, they can take a break and reestablish comfort and trust by holding each other and remaining calm before trying the exercise again.


Some people avoid seeking sex therapy because they’re afraid of exposing themselves, whether physically or emotionally. Others, unfortunately, fall victim to a common public misconception that sex therapists don’t work with mainstream, traditional couples. But most couples are traditional in the sense that they value their couplehood and maintain a traditional agreement about not having sexual relationships with others.

Shaking off shame: Many partners silently worry that their mate wouldn’t love or respect them if they knew their deepest sexual secrets—unusual turn-ons, colorful histories, long-ago rape or abuse or a sexually transmitted disease. But confronting these issues in sex therapy typically reveals acceptance, not intolerance. Partners learn that their secrets no longer control them.


Finding a qualified sex therapist isn’t always an easy task. Most marital therapists are not trained to deal with sexual issues directly. In traditional couples therapy, sex problems are almost always considered to be a symptom of relationship problems, so sexual attitudes, behaviors and feelings are not directly addressed. Also, most states don’t have licensing requirements for sex therapists.

The nonprofit American Association of Sexuality Educators, Counselors and Therapists (AASECT) offers an easy-to-use online tool to help locate certified sex therapists in most parts of the US. Unfortunately, most health insurers don’t reimburse for sex therapy.


To find the right therapist, look for a practitioner who…

  • Has a degree in mental health, such as a doctorate of psychology (PhD) or a master’s in social work (MSW).
  • Is certified by the AASECT to practice sex therapy.
  • Has at least three years of experience working with couples—including significant experience dealing directly with sexual issues.

It’s worth the effort to find a therapist whom both partners like and respect. Talk to several therapists on the phone or e-mail a few to get a feel for who might be a good fit.

Source: Barry McCarthy, PhD, a professor of psychology at American University in Washington, DC, a Diplomate in clinical psychology and a certified sex and couples therapist who has practiced for 42 years. In 2016, he received the Masters and Johnson award for lifetime contributions to the field of sex therapy. The author of 14 books, including Sex Made Simple and Rekindling Desire, he has presented more than 400 professional workshops in the US and internationally.