Why Sex Therapy? Why Not?

The word “sex” can conger up many different things for people… pleasure, fun, intimacy, anxiety, shame, pain, etc. When people hear that I’m a Sex Therapist, I also get many different responses. Most people laugh and make a joke about needing me to talk to their significant other. Others comment on how cool it is (I think it’s cool!) and others appear confused and ask what does that mean or does that mean I have sex with my clients. For the record, sex therapists do not have sex with their clients. To do so would be extremely unethical and lead to losing their license to practice therapy. Given that there are so many thoughts and feelings that come up around sex and the idea of sex therapy, I hope to provide some background on what it is, why I chose to pursue this path, and what I actually do.

Sex therapy is a growing but often misunderstood type of psychotherapy. I honestly never even considered it as a career path because my counseling education and clinical training provided little in the way of information in working around sexual issues with clients. The first time I heard about sex therapy was while I was working in substance abuse and attended a four day training called Sexual Health in Recovery. This ended up being one of the best trainings I had attended so far in my clinical education and led me to be curious about the field of sex therapy. During that training, attendees had to engage in a few activities around exploring their knowledge about sexuality. Many of these activities were fun but also eye opening in helping to better understand my own biases around sexuality. I remember seeing the name of an organization in the handbook that was provided called AASECT (American Association of Sexuality Educators, Counselors, and Therapists) and decided to do a little research. I discovered that at that time (summer 2013) there were only six certified sex therapists in Baltimore. That was a bit of a shock because I always thought of Baltimore (home of the very kinky John Waters’ films) as being a more sexually open kind of city where there would be a great need for sex therapy. I was now even more motivated to figure out what this field had to offer. The next thing I researched was how to become a certified sex therapist.

Prior to the Sexual Health in Recovery training, I had been considering what direction I wanted to take as a psychotherapist. There are many paths a Licensed Clinical Professional Counselor (LCPC), like myself, can take. I knew I eventually wanted to be in private practice, but I also wanted to figure out a specialization that would be interesting and helpful for future clients... as well as something where I wouldn’t experience a lot of burn out. There were plenty of workshops that offered weekend trainings to receive certificates in a variety of treatments like cognitive behavior therapy, mindfulness, etc. These were treatments I already knew but thought maybe having a piece of paper indicating my certification would make me look more professional. There were also trainings that were for a longer duration (a few months) where I could get certified as a trauma specialist or similar. I was interested but not as motivated in pursuing one of those paths. It wasn’t until I learned about sex therapy that I made some decisions in doing more to pursue a specialization.

When it came to sex therapy trainings, living and working in Baltimore became a challenge. I couldn’t believe that none of the local colleges and universities did not offer sex therapy trainings. The closest area that had anything viable was Philadelphia. I signed up for a sex therapy certificate program in Philly and for one year, I drove up to Philly from Baltimore one day a week to attend classes. It was quite a commute, but I loved what I was learning! There was so much more the field of sex therapy covered than I expected… such as working with sexual dysfunctions, infidelity, desire, sexual trauma, questioning sexuality, sexual shame, sexual anxiety, kinky sex, polyamory, out of control sexual behaviors, etc. It was both overwhelming learning so much but also fascinating. Looking back, I remember not once did I question whether this was the right path for me… It most definitely was.

So the easy part of becoming a sex therapist is attending the trainings and classes. The hard part is when you first start working with actual sex therapy clients. You attend classes and learn all kinds of things that the average person doesn’t really think about and now you need to look like you know what you’re talking about all the while trying to put the client at ease (because they are probably 100 times more nervous than you are talking about sex). It was very daunting when I first started out. Luckily, you get the hang of it after many sessions and you get some help from people more knowledgeable that you. A requirement of becoming a certified sex therapist is to undergo supervision by someone who is both certified as a sex therapist and as a supervisor in sex therapy. I ended up having two amazing supervisors. It usually takes around 3 years to get certified in sex therapy which is why it is so important to have mentors during that time period. The supervision was immensely helpful in shaping the kind of sex therapist I wanted to become. I was able to learn different therapeutic techniques and gain a better understanding of what actually happens during sessions. What was also helpful was meeting others who were in the process of becoming certified. The other therapists I have had the pleasure to meet and attend trainings and group supervisions with are truly some of the coolest and most open minded people I have ever encountered.

So what does a sex therapist do? Well, we do a lot of the same things as other psychotherapists but much sexier (kidding… not kidding). Sex therapy involves having a lot of knowledge about human sexuality and also having a very open mind in regards to the myriad of sexual behaviors people engage in. Most psychotherapists who have not gone through sex therapy training, often have little knowledge about these things. Here’s a short list of issues that may bring a client into my office- partner relational problems like desire discrepancies, sexual dysfunctions (ex// Erectile Disorder, Female Orgasmic Disorder, Sexual Interest/Arousal Disorder, Substance Induced Sexual Dysfunction), Gender Dysphoria, Out of Control Sexual Behaviors (OCSB), kink, polyamory, and fetishes. Sex therapy starts with a detailed assessment of the issue(s) bringing the client to therapy and the client’s background. A thorough assessment into the clients’ sexual history is very important as well. This does not mean just asking about past sexual behaviors but also understanding how clients learned about sex, what thoughts and beliefs around sex do they have, and figuring out what are their goals in coming to therapy. After the assessment, the sex therapist and client(s) collaborate on what goals to work towards depending on the presenting issue. A variety of therapeutic techniques may be used to reach these goals. These can include specific therapies like Cognitive Behavior Therapy and Mindfulness, psychoeducation on sexuality, working through past trauma, assigned activities to try at home, books to read, videos to watch, etc. Many sex therapists will also get other professionals involved when needed. These can include psychiatrists for medications, specialists like urologists and endocrinologists, and pelvic floor physical therapists. Sex therapists do quite a bit.

When it comes to doing sex therapy, all I know is that I love it. There is something special about having a client who needs to address what is often a very tough subject to talk about and give them a safe place to do it. Given how our society often treats the subject of sex (usually from two extremes- using it to sell almost everything to shaming people who engage in it “too much” or in unconventional ways) talking about sex can cause a lot of anxiety. Luckily, sex therapists are highly trained and open-minded and do all they can to create more curiosity around the topic of sex. I hope that by sharing some of my own background in this field, it will create some of your own curiosity and give you a reason to see what sex therapy is all about.