What Is Sex Therapy?
Understanding Sex Therapy
Counsellors receive training in a lot of various areas such as treatment of anxiety and depression, helping reduce negative relationship patterns, and growing through past hurts and traumas. Strangely, very little, if any, counsellors' training requires specific education in treating sexual difficulty or supporting healthy sexual expression.
Sex therapy points to a specialization and specific focus from the therapist in helping in areas of sexuality. There are various accreditations and certification programs that can give individuals the confidence that their therapist has met a minimum standard of education in this field. AASECT (American Association of Sexuality Educators, Counsellors, & Therapists) is one such organization. I am currently in the process of applying for certification with AASECT, and enrolled in further sex therapy training through the Sexual Health Alliance which is another outstanding organization training helping professionals in the area of sexuality.
In sex therapy, there is permission to talk about all the things regarding sex that maybe you were too afraid to ask about. “Is this normal?” is a very common question many people come with to sex therapy. Talking with a therapist about things you may have been told are “inappropriate” to talk about can feel freeing and also maybe a little scary or uncomfortable.
Know that any question you have has been asked by others before you and is very welcome in the work together.
Common Areas of Concern or Focus in Sex Therapy
Desire Discrepancy
Many couples come to sex therapy because of a difference in how much sex is wanted in the relationship. Some might call it “low libido” but there are so many factors that can influence this challenging mismatch. Almost all couples have a difference in the amount of sex they desire, and this can change over time and in different seasons of the relationship. Ultimately, the larger the desire discrepancy, the more difficult the impact on the relationship. Working with the couple to identify what is getting in the way of the sexual connection they both want is an important step in this process. Seeing this as a shared concern is also important in reducing how much stress this issue puts on the couple’s overall happiness together. Specific plans and interventions are often part of the work, building trust that this area of their relationship is important to them both.
Sexual Functioning Concerns
Sometimes sexual difficulties can come from certain medical conditions and those need to be addressed with the help of a medical professional. Often though, all or a portion of the issue can arise from psychological or relationship difficulties. Some clients struggle with the pressure to maintain an erection, while others worry about reaching orgasm faster than they’d like. Painful penetration can be a real barrier to desiring sex, and others experience a challenge to have the pleasure or orgasms they desire. All these issues as well as others are important and relevant work within sex therapy.
Opening Up The Relationship
Couples who are looking into ethical non-monogamy (ENM) in its many forms find working with a sex therapist can be important as they navigate the tricky dynamics that can arise. Open relationships are not a one-size-fits-all scenario. There are so many different options and arrangements when pursuing some degree of relational or sexual openness.
Some couples enjoy purely engaging in sexual play with others at events, “aka swinging” while others desire multiple romantic partners including dating (polyamory).
Understanding the reasons why people may pursue something other than monogamy can be confusing to the larger society and lead those in ENM to feel unsupported when struggling. Working with a therapist to navigate concerns like jealousy, relationship agreements, and sexual safety concerns can be vital. It's important that those exploring or navigating ENM feel their therapist is affirming and non-judgemental, offering tools and perspective to better navigate their ENM relationships. I value helping couples spot potential pitfalls while working to configure their unique relationship to have the openness and stability they desire.
Sexual Shame
The values that many people have grown up with are largely “sex-negative”. This means sex was largely a topic that could not be talked about and was something to be feared as dangerous. Those who grew up in religious upbrings with strict rules around sex often experienced this most acutely. As a person grows through adolescence and their sexuality emerges, the silence, fear, and isolation can infect a deep sense of shame about one's own sexuality. Even those who married within the framework they were taught as ‘correct’ often still struggle to rid themselves of deep feelings of sexual shame and guilt, limiting how they can show up sexually with their spouse. Sex therapy provides a space to begin unlearning shame and sex-negative values that are blocking the integration of their sexuality.
Sexual Trauma
Unfortunately sexual trauma is very familiar to many individuals. These violations impact a person’s sense of safety in their own body and can greatly interfere with healthy sexual development and expression. The fact that there is often so much shame and secrecy around these violations can hold a person back from healing. Working with a sex therapist can help a person process what they’ve experienced and find next steps towards healing these wounds.
Kinky vs Vanilla
There are so many types of ways to experience sex, pleasure, and desire. Some couples find compatibility quite easily while others struggle to map a course of pleasure-seeking that satisfies them both. Sex at the beginning of a relationship (often referred to as the Honeymoon Phase or NRE, New Relationship Energy) can mask differences in sexual preferences because erotic newness and passion can hide these differences.
Later on, the question will often shift to “what kind of sex is worth having?” Which means that sex can get pushed down the list and less prioritized if they aren’t finding the type of pleasure they desire in the sex. There is a saying in sex therapy “Don’t Yuck My Yum” which translates to, what turns one person on, may turn another person off. Some like sex that is sweet, romantic and simple, while others prefer it spicy, rough, and imaginative. Kinky refers to things not as mainstream like BDSM. Vanilla sex refers to a more simple, romantic, love-making.
Helping couples work on sexual communication around wants and desires is an important part of sex therapy. Navigating the differences in spice levels is important relationship compatibility work.
Sexual Orientation & Gender Diversity Exploration
Exploring one's sense of self and identity regarding sexuality and gender can be an important part of sex therapy. Our larger world presents gender in the binary (men and women) and heterosexuality as compulsory. Many people sense that this doesn’t fit just right for them, but often lack the clarity of what actually does fit for them. Exploring the unique ways a person relates to gender, femininity, androgyny, and masculinity is beautiful self-discovery work. Clients are supported in navigating the challenges that can come from gender dysphoria, internalized trans/homophobia, and cultural / religious taboo. Clients are encouraged in their exploration process as they find peace in an integrated sense of self and build a life that reflects their truest identity.
Problematic Compulsive Sexual Behaviours
Sexuality can at times result in behaviours that hurt or violate others. Seeking help with these issues is important and help from a sex therapist to address and curb problem sexual behaviour is key. Some people use the paradigm of “Sex Addiction” to describe this type of issue and utilize the “12 Step Model”. There are several reasons I believe this is misguided and can do more harm than good. The 12 Step Model focuses on sexual “sobriety”. With this intent, it sets individuals up for failure because one never is without a sexuality, regardless of their behaviour.
It also has a tendency to be sex-negative and pathologize normal sexual development and experience, such as a teen discovering masturbation, a married person sexually desiring someone besides their spouse, or even telling gay people that their sexual orientation is somehow wrong. A sex-positive harm reduction model looks at curbing actually harmful sexual behaviour that violates others, while working to create a healthier relationship to their sexuality as a whole.
I have a passion for helping people grow through using sex therapy; finding the missing pieces of sexual education they need and internal permission to experience the sexual experiences they desire. If any of this resonated with you, please reach out to book a free consultation. I’m looking forward to working with you.
David Carlson MA, RCC
