The topic of sex is intimidating in many cultures, but the notion of needing treatment or therapy in that arena can feel even more embarrassing. The stigma against reaching out for any psychological problem can feel daunting, but this fear gets amplified when sexual dysfunction is involved. There are also a lot of fears about sex therapy because most people don’t really know what it entails.
Sex therapy is a form of talk therapy that utilizes cognitive-behavioral interventions to address concomitant psychiatric conditions such as depression and anxiety disorders that are related to sexual disorders such as inhibited sexual desire, premature ejaculation, retarded ejaculation, hypoactive sexual desire,painful intercourse, and orgasmic disorders. Sexual arousal disorders are found in both males and females. While males may be interested in sex, erectile dysfunction may effect sexual functioning. Similarly, women may desire sexual intimacy but they are unable to maintain the vasocongestion (lubrication-vaginal swelling response of normal sexual excitement) to experience pleasure.
Sex therapy is also an educational process correcting sexual misinformation and dispelling myths. It also focuses on the importance of improved partner communication; on promoting honesty; providing anxiety reduction (including fear of performance failure); encouraging the individual and couples to explore new ways of engaging in sensual pleasure; and assisting in helping both the individual and couple accept 'self' and each other as unique human beings as well as sexual partners.
Sex therapy, like any other therapeutic process, begins with taking a thorough history of the patient's problem(s). Due to the possibility of both biogenic and psychogenic factors in male sexual dysfunction, a consultation with a urologist is often recommended to identify and treat any biological factors before proceeding with psychotherapy. Likewise, women are usually encouraged to have a complete workup with a gynecologist to address female sexual dysfunction (FSD) to rule out any organic problems that may be contributing to FSD.
An underlying assumption of sex therapy is that relatively short-term outpatient therapy can diminish symptoms of sexual dysfunction, alleviate learned patterns of unhealthy sexual behavior, and allow a greater satisfaction with partner intimacy and sexual experiences. In cases where significant sexual problems are linked to broader emotional problems such as depression or substance abuse, and/or medical problems (i.e., physical illness, cancer, medication complications or PTSD), intensive psychotherapy, and/or referral for medical or pharmaceutical intervention may be appropriate.
Limitations of Sex Therapy
As with any therapeutic intervention for psychological or behavioral problems, sex therapy has its limitations. Although most sex therapy is usually brief, time-limited, and offers interventions that are based on evidence-based therapy techniques which have been proven to be effective for most sexual concerns, sex therapy does not offer a miracle cure for all relational problems.
Successful treatment depends upon many factors including: the nature of the sexual problem; the motivation of the patient's (and couple's) desire to change; the therapeutic goals set forth when treatment began; and the therapist's clinical skills. Furthermore, the prospective patient and/or couple should choose a therapist carefully and establish realistic goals early in the therapy process. All therapy agreements depend upon establishing trust and mutual respect, but this is particularly true when working with intimate issues of sexuality.
Role of the Sex Therapist:
When I introduce myself as a psychologist, sex therapist, and post graduate sex educator, I usually get a lot of giggles or comments like, "Gee, I could really use your help!" Their comment is sometimes followed by an awkward pause or a diatribe of what they think sex therapy is all about. Fantasies about the role of the sex therapist abound, (as depicted in the picture above), but rest assured, the ethical therapist will follow strict ethical guidelines that are intended to provide safety for all concerned – patient and therapist alike.
Although qualified sex therapists may differ widely in their basic approaches to the treatment of sexual problems, some generalizations can be made. One of the first orders of business it to dispel the myths around sex therapy. It is also to provide ACCURATE evidence-based information about why the person is seeking help. 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.
Additionally, you might be asked to read selected books or view clinical films designed specifically for use in sex therapy. However, you should not do anything which you do not understand, and you have the right to question the purpose of any assignment. Every homework assignment, task, or experience presented by the therapist should fit into an understandable and acceptable treatment plan. However, it is your right to decline or postpone acting on the suggestions of your therapist.
Our comprehensive training as a sex therapist encourages us to have a particular awareness of the continuum of sexual identity and sexual expression, one that transcends personal opinion or personal experiences. Also we tend to have a greater than average knowledge about the physiological processes associated with human sexuality and work collaboratively with physicians and allied health care professionals to address the entirety of the causes of sexual concerns and dysfunction.
Most sex therapists believe that many sexual disorders are rooted in learned patterns of behavior and family-of-origin values. These are termed "psychogenic disorders." As a child grows up, they observe interactions between their parents and others, and are subjected to various messages about their sexuality. Conflict or other problems in parental relationships (including sexual problems in marriages/relationships), can be transmitted to children and can result in the formation of unhealthy notions and attitudes about sex, about one's genitals, or about the body in general. Moreover, parents, care givers, religious institutions, and societal norms may convey very repressive attitudes about sexuality that contribute to the development of assorted sexual dysfunctions.
Sex therapists do not make value judgments about paraphilic (or fetish) sexual practices or pair-bonding outside of heterosexual monogamy; rather anything goes as long as it is SAFE, SANE (as defined by the couple or persons involved) and CONSENSUAL. Most sex therapists are "sex-positive" and hold the view that healthy sexual practices open the doorway to a fulfilling and abundant life and tantric bliss. 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.
We hold a positive outlook on the beneficial influence that sexuality can have on people's lives and in the world in general. And we are not naive about the ill effects that occur as a result of sexual abuse or sexual encounters that are not consensual. These issues are addressed from a rigorous scientific perspective and with specific ethical guidelines, rather than from a personal ideology or dogma.
When there is a clear indication of sexual dysfunction, treatment is tailored according to the unique circumstances and issues presented before us according to evidence-based practices in the field of sexology. With the exception of when separate sexual surrogate therapists are added (in a very small number of cases, and only if licensed in your particular State), sex therapy is completely 'talk therapy.'
What Sex Therapy is NOT
Under no circumstances should you have to take your clothes off in a sex therapist’s office – EVER - unless your therapist is a licensed physician and prescribes a physical examination as part of your initial evaluation. In such cases, there will ALWAYS be an assistant in the room – ALWAYS. Sexual contact between patient and therapist is considered unethical and is destructive to the therapeutic relationship (unless the therapist is acting as a sexual surrogate).
There is a very good reference that describes many issues related to sexual surrogacy in To Refer Or Not to Refer - Surrogate Partner Therapy: The Renewed Interest and Rekindled Debate Regarding Surrogate Partner Therapy. Definitions, Debates, Questions, Ethical-Legal Considerations, & Resources http://www.zurinstitute.com/surrogate_partner_therapy.html. More information about surrogacy can also be found on http://www.surrogatetherapy.org/.
Furthermore, you should NOT be expected or 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 as your unique self in your sex therapy experience free from bias or stereotype and feel that you are being treated as an individual, not as a classification.
Be Picky about choosing a Sex Therapist
When choosing a CERTIFIED sex therapist, it is appropriate to ask lots of questions and request a copy of their credentials before scheduling an appointment. This is especially important because anyone outside of the state of Florida can hold out a shingle and claim to practice sex therapy. However, Florida has very specific guidelines that regulate the practice of sex therapy https://www.flrules.org/gateway/ruleno.asp%3Fid%3D64B4-7.004, so you can be sure the person you choose in Florida is qualified.
Questions to ask
There are several criteria that should be considered when choosing a sex therapist. First of all, the therapist must have a thorough knowledge base of the anatomical and physiological bases of the sexual response cycle. The sex therapist may have a medical background or may have a non-medical profession but with post-graduate education in the biological aspects of human sexuality.
Secondly, the qualified sex therapist must be skilled in providing psychotherapy. Most sex therapists have a comprehensive background in psychology, psychiatry, psychiatric social work or psychiatric nursing. This clinical background is essential to the understanding of the total individual and for the planning of an individualized (or couple) treatment program. Clergy (of various religions) may provide sex therapy as well, however, they must demonstrate specific post-graduate training in pastoral counseling or in equivalent psychiatric mental health areas.
The third criterion is that the sex therapist must be able to demonstrate extensive post-graduate training specifically within the areas of sexual function and dysfunction, sex therapy techniques. Most raining programs have a comprehensive curriculum that covers these topics in detail. 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 understanding couple dynamics and relationships which includes training in marital, family and/or group therapy. In order to work effectively with sexual problems, the sex therapist must be able to work effectively with non-sexual relationships as well. Since sexual behavior does not occur in a vacuum, the total relationship must enter therapy and be accurately evaluated and treated.
The final and MOST IMPORTANT requirement is the therapist's adherence to a strict code of ethics. Prospective patients and couples have the right to request a copy of the therapist's ethical code before agreeing to any treatment. You may also want to do a background check to make sure the individual actually holds a current license in their particular professional discipline and to make sure they do not have any disciplinary actions against them.
Fees for Sex Therapy
Fees for sex therapy will vary widely based on the therapist's level of training and experience. Certified practitioners of sex therapy often hold degrees in marriage and family therapy, social work, theology, psychology, nursing, or medicine. Obviously, whatever fees are being charged in their clinical practice will reflect the fee structure they will offer for sex therapy. It is important to keep this in mind because you are getting the benefit of their experience in their primary discipline as well as their certification as a sex therapist.
In sum, Sex Therapy employs a dynamic approach to treating very real sexual and relationship 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, is a very sensitive treatment modality and by necessity must include respect for the individual and couple's core values. It is intended to be nonjudgmental and unbiased, recognizing one's unique sexual identity, providing equal rights for all genders, and promote sexual fulfillment, and pleasure in healthy sexual relationships withiin ethical guidelines that are founded upon evidence-based therapy techniques. Feel free to schedule an appointment with this office at 954-779-2855 to discuss how you could benefit from sex therapy.