Sex Therapy; What is it and who needs it? 

I’m often asked about my work as a sex therapist.  I’m surprised at how few people have any sense of what a sex therapist does.  While I can’t speak for all my fellow therapists, I can tell you a bit about my own practice. 

Mostly the work I do is Cognitive Behavioral Therapy (CBT). Those of you who read around Dr. Dick's Sex Advice or regularly listen to my podcasts will recognize this approach.  Basically I suggest that people with sexual problems change their behaviors as a sure fire way to address their problems.  I’ll explain more in a bit.   

I practice a kind of therapy that is short term, goal directed and personally liberating. I don’t believe this kind of therapy should become a lifestyle. And I try to give my clients the tools they need to successfully work things out their own. 

I encourage my clients to give themselves permission to investigate their sexuality.  This in turn assists them in taking charge of making themselves feel better and/or perform better.  And as soon as they do, they almost immediately have a greater sense of wellbeing.  Like they say, nothing breeds success like success.   

Once we identify an area of concern, we create a plan of action, which my client will implement.  I believe the more an individual is part of his or her own healing process, the more productive the process will be. 

The work I do is short-term, goal-directed and personally liberating. This approach doesn’t fit everyone.  But 99.9% of the people that I work with respond positively. One thing for sure, I do not in any way shape or form make my clients dependent upon me. I think it’s morally indefensible for a therapist to do that. 

I find that fewer and fewer people are willing to give their sexual issues the attention they deserve.  Frequently I encounter a “give me a pill for that” mentality.  Rather than investing the time and energy to get to the bottom of their performance issues, some people would rather opt for the quick fix.   

Often they’re unwilling to make the necessary lifestyle changes to actually solve their problems.  For example, I often see people who are eating themselves to death, or seriously abusing alcohol or drugs.  Of course they have the accompanying sexual response issues, erection problems for men and arousal concerns for women. They may want to resolve their issues, but without committing to a change in behavior.  Like, I want my erection back, but I don’t want to quit myth — that sort of thing.  This sort of situation almost always ends in disappointment. 

Sexual dysfunction, of one sort or another, is the most frequent presenting issue I see in my practice.  Although, the reason why a client reaches out to me for help varies.  Sometimes an individual’s tolerance level for a problem peaks and he or she finally decides to do something about an issue that may have been smoldering for years.  Sometimes it’s a person’s partner who brings in the proverbially “broken partner” and tells me to fix him/her.  I’m always delighted when that happens, don’t cha know. 

Couples often seek sex therapy together.  I suppose sexual concerns are more obvious when one is part of a couple.  Mostly, by the time the couple comes for therapy, the sexual issues have been plaguing them for a while.  The relationship comes close to being over before the couple wakes up and smells the coffee.  For example: say a guy brings in his wife because she’s no longer sexually responsive, whatever that may entail.  They’ve been married for X-number of years and he’s finally had it.  She, on the other hand, clams up. Because she is uncomfortable, talking about sex.  She doesn’t want to be in therapy, because she doesn’t really think there is anything wrong with her.  She just doesn’t want to have sex anymore. 

This is a difficult way to start therapy.  Resentments are high and frustration rages.  If the couple actually continues with me, we soon discover there is also something desperately wrong with the husband.  Inevitably we discover he’s a crummy lover and his inability to pleasure his wife is the cause for her arousal dysfunction.  It’s often painfully clear that the guy knows little or nothing about a woman’s anatomy or the female sexual response cycle.  The wife, on the other hand, has never had permission to know her body, so she is unable to help her husband or direct him on how to properly pleasure her.  As you can imagine, in a case like this, there’s a load of remedial sex education that must come before anything else is resolved. 

Another example would be one person in a couple brings in the other with the declaration that he or she has been cheated on.  The one tells me, in no uncertain terms, that this therapy is the last ditch effort before divorce or the end of the relationship.  Often in cases like this, it’s way to late for any real intervention, because each is so angry and shamed, the chance of us turning this around is very slim indeed.  Sometimes the best we can do is end the marriage or relationship with as little acrimony as possible. 

In difficult couple counseling, my first effort is to get the couple to disarm.  There will be no sex therapy, and god knows there is a need for sex therapy, till there is some semblance of peace in the marriage or relationship.  If we don’t establish at least a small bank of goodwill between them our efforts are doomed. 

Of course there are plenty of individuals and many couples who haven’t waited till the last minute to seek help.  These people want to be proactive about their concerns.  Some people simply need some clear unambiguous information about human sexuality.  A surprising number of people are really trying to piece together their sexual lives, but are hampered by misconceptions and misinformation. 

Sometimes a traumatic event will motivate a person to address arising sexual or intimacy issues.  A disease process, a death or an accident can fundamentally alter the power dynamic of the relationship, which will require a rethinking of the entire relationship. 

Perhaps someone comes to a new realization about him or herself.  This will surely impact on the life of the individual, but if that person is in a relationship, the relationship is impacted too.  Say a person discovers, or is finally able to acknowledge his/her bisexuality, or that he’s gay, or she’s a lesbian.   If one discovers, or is finally able to acknowledge a fetish — he’s a cross dresser or she’s into another kink. These things can precipitate a visit to my practice.  Most people in this sort of predicament aren’t sure how to talk about this new discovery.  And if they are in a relationship, they are often clueless on how to discuss this with their partner or significant other.  

Some couples don’t fret when the sex goes out of their relationship.  Other couples are devastated when the sexual connection is extinguished. What does one do when one partner still has sexual needs, but the other no longer does?  Often times there are unexplored options that will hold the relationship together, but will address the disparity in sexual interest and desire. 

In this case, I can help the couple make compromises without losing their moral compass. Some couples navigate this with ease; others not so much.   There are ways to preserve what’s sacred about a primary relationship, while contemplating opening the relationship to include others.  I can help a couple establish guidelines and ground rules for making the necessary adjustments. 

Sometimes the relationship is really wonderful and fun.  The couple really loves each other, but they’ve noticed their sex live together is pretty boring.  I’m often approached to simply help a couple spice things up.  In this instance, my work is sheer joy.  Mostly I just give the couple permission to experiment and have fun. 

You’ve probably noticed that a good portion of the work that I do as a therapist is merely giving permission.  That may sound like no therapy at all, but when you consider that our sex-negative culture is so full of prohibitions; permission giving is often the front line of sexual rehabilitation.  Most of the permissions I give are for an individual to educate him or herself about his or her body and his or her sexual response cycle.  And personal exploration, such as masturbation, is the very best means to that education. 

Happily, our need to reacquaint and reeducate ourselves our bodies and our sexual response cycle is a life-long process.  There is always something new to explore.  For example, as we age our bodies change.  And if we don’t keep up with those changes, we can become frustrated and disoriented.  Older people, menopausal women and andropausal men, take longer to build up a head of sexual steam, so to speak.  If we’re not attuned to the changes in our body and our sexual response cycle, we could easily miss the important cues our body is sending us to slow down and enjoy the sensuality. 

Of course, I could go on and on.  And maybe, I’ll pick up this thread again later.  Right now I want to leave you with what I believe is the distillation of years of thought about the role sexuality plays in our life. 

I believe that sex is like food.  We can enjoy it alone, or with others.  We can be abstemious, or a glutton.  We can nosh or nibble; dine or devour.  And we can be certain there will be both times of feast and famine. 

Sex is like food.  It can nourish and sustain us, or it can make us sick.  We can consume all of the available bounty, or restrict our diet.  It can be both bacchanal and sacrament.  It can completely satisfy, or leave us devastatingly empty. 

Sex is like food.  We can utilize it to express your highest aspirations, or allow it to rob us of our soul.  We can give it as a gift, or use it as a weapon.  It can fill our senses or simply be an exercise of our mind. 

One thing is for sure, whether it is purely physical or transcendentally spiritual, no one can live without food…or sex.

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