The role of sex therapy
| January 1, 2007
In-Depth Report
The role of sex therapy
Sexual problems are nearly always intertwined with psychological issues. As a result, solving the physical problem (if one is present) is only half the battle. If sexual issues persist for any length of time, performance anxiety, anger, frustration, low self-esteem, lack of physical affection between you and your partner, and a sense of hopelessness about the problem can further debilitate your sex life. So can a tendency to blame yourself or your partner for the problem. Most people need help repairing the emotional distance created by the problem before they can regain a healthy sexual relationship.
Licensed sex therapists are particularly well suited to this task. Although they're qualified to understand the same broad emotional issues as individual or couples therapists, sex therapists have advanced training in addressing specific sexual problems, and they use a more targeted approach. Initially, underlying personal dilemmas and relationship conflicts are addressed only in the context of your sexual problems. As a result, sex therapy will probably return you to sexual functioning sooner than traditional counseling. However, once the sexual issue is resolved, many people continue working with the sex therapist or another mental health professional to tackle deeper personal and relationship issues.
Sex therapy in the age of erectile dysfunction drugsWhen Viagra was first introduced, some sex therapists worried they would shortly be out of a job. But they soon learned otherwise. Erectile dysfunction can set in motion a cycle of emotional and relationship problems that need addressing. Likewise, an instant "cure" in the form of a pill can uncover other sources of sexual dysfunction, such a low libido, difficulties with arousal, or vaginal pain from menopausal changes. If Viagra, Levitra, or Cialis allows you to resume sex after a hiatus, a sex therapist can help you transition back to sexual activity. These are some of the therapist's tasks: Determining whether both members of the couple are comfortable with and committed to using the drug. Discussing the conditions each person needs for pleasurable sex. For the woman, this may mean more romantic time that includes talking, affection, and sensual touching before moving to sexual activity. The therapist will also encourage the couple to learn how to adjust their lovemaking to incorporate the waiting period (if there is one) while the medication takes effect. (This interval may actually serve to encourage the type of sensual lovemaking that sex therapists recommend.) Exploring expectations for resuming sex. The therapist can help you accept that sex will sometimes be just okay, that arousal problems may still occur, and that these medications won't work without desire and physical stimulation. Addressing other sexual issues the man may have, such as ejaculatory problems. Delving into emotional and relationship issues that are interfering with intimacy. Devising strategies to deal with instances of unsuccessful intercourse. |
What to expect during sex therapy
To understand what takes place during a sex therapy session, it's important to know what doesn't happen. Contrary to popular misconceptions, you will not undress in front of the sex therapist, make love while he or she is watching, or have sex with anyone other than your partner. If having to discuss your sex life with anyone other than your partner and perhaps your doctor is an obstacle to getting help, you can rest assured that the sex therapist will not push you too quickly. Also, part of the treatment process is learning how to talk about your sexual feelings more comfortably.
The role of sex therapy is to help people explore their sexual concerns, better communicate their sexual needs, and expand their repertoire of sexual and sensual activities. By increasing the overall pleasure and intimacy of sexual contact, a couple will be able to enjoy expressions of sensuality that are free from the goal-driven pressures of intercourse and orgasm.
Masters and Johnson pioneered sex therapy in the 1960s. The original model consisted of an intensive two-week treatment program revolving around daily therapy sessions. Couples traveled to the Masters and Johnson Institute and stayed in a hotel for the duration of the treatment. Although intensive weeklong or weekend programs are still available at a few centers around the country, most practitioners use a modified format in which the couple meets with the therapist in his or her office for weekly 50-minute sessions. There are certified sex therapists in most major cities, so you won't need to travel far from home to get help.
Much of the work of sex therapy is actually done at home between meetings with the therapist. After the initial getting-to-know-each-other period, the therapist will assign you and your partner materials to read or behavioral exercises to practice at home. You'll be asked to focus on your feelings and sensations during the assignment and to discuss them with the therapist in the next session.
The therapist may also serve as a sex educator. In many cases — for example, with age-related changes or vaginal pain syndromes — understanding the physiological basis of the problem often goes a long way toward relieving your anxiety, as well as your partner's. The therapist will discuss such issues with you during therapy sessions and may suggest useful books and videos. He or she will also challenge erroneous beliefs that stand in the way of enjoyable sex, such as "All sexual contact must lead to intercourse," "The man must be in charge of the sexual activity," or "Foreplay is only for teenagers."
Sex therapy can also help you learn to control other factors that inhibit your sexual performance. By understanding where stressors lie and how they influence sexual functioning, a couple can take steps to create a relaxed, distraction-free environment for sex. Older couples who need more time to reach arousal and orgasm may find they benefit from making an extra effort to set a romantic mood.
Overcoming anxiety about sex therapyIf you think sex therapy may be helpful but you're still uneasy about it, there are several ways to learn more about this treatment. Sexual self-help books and videos often describe exercises that a sex therapist might assign. Many even include a chapter explaining sex therapy. Your primary care doctor, gynecologist, or urologist may also be able to tell you something about the process. Even if they understand what's involved in sex therapy, couples may be hesitant to take the first step. Anxieties revolve around the fear that something serious is wrong with them, that sex therapy will hurt their marriage by focusing too much on the problem, or that if the therapy doesn't work it means the situation is hopeless. During an initial phone call, a sex therapist will be able to address these issues and very likely ease your anxiety. Sex therapy is most successful when both partners are willing participants. However, if one partner is resistant, the other may seek treatment alone. In this case, the sex therapist may encourage the hesitant partner to attend for at least one session in order to discuss his or her thoughts on the issue. If the partner is unwilling to engage in therapy even to this extent, it's still possible for the other partner to benefit from the process. |
Sensate focus: The foundation of sex therapy
The cornerstone of sex therapy is a series of behavioral exercises called sensate focus exercises. These highly structured touching activities are designed to help you overcome performance anxiety and increase your comfort with physical intimacy. Sensate focus training also helps teach you about your partner's body as well as your own.
Initially, the couple agrees to refrain from intercourse or genital stimulation until the later stages of treatment. This helps dispel anxiety that's built up around sexual performance and allows you to establish new patterns of relating. Couples and therapists also negotiate how frequently the couple will perform the assigned exercises between therapy sessions.
Occasionally, couples are reluctant to complete the homework assignments. This too can be revealing. By delving into the roots of this resistance, the therapist can better understand the origins of the problem.
How it works
Sensate focus techniques progress through several stages. The therapist will provide a detailed individualized scenario for the couple to follow at each level, but here is an overview.
Sensate focus I. To start off, you're encouraged to spend about an hour caressing each other's naked bodies front and back, from head to toe, but avoiding the breasts and the genitals. You and your partner take turns being the giver and receiver of pleasure so you can concentrate fully on each sensation and your reaction to it. However, if this creates too much anxiety or is too intimate for the couple, the therapist may recommend beginning simply by holding hands or giving each other back rubs. During these initial exercises, the emphasis is on the giver touching in a way he or she enjoys, barring anything that is uncomfortable or unpleasant for the receiver.
Sensate focus II. These exercises incorporate the lessons from sensate focus I, but the focus expands to the kind of touch the receiver wants. He or she takes an active role in explaining or showing his or her partner what kind of touch is enjoyable. Partners still take turns being the giver and receiver during each session.
Sensate focus III. Building on the previous sessions, these exercises expand to include touching the breasts and genitals, but not exclusively. The couple is encouraged to continue focusing on the sensations involved and on communicating what they enjoy and want sexually, rather than the goal of orgasm.
Sensate focus IV. At this point, the couple is allowed to enjoy mutual touching and stimulation to the point of orgasm. If all goes well, the couple can proceed to intercourse.
Depending on the needs of the couple, the sex therapist may also use other behavioral techniques and treatment strategies.
Finding a sex therapistThere are several approaches you can take to finding a qualified sex therapist. Your gynecologist or urologist may be able to make a referral. Also, if you're working with an individual or couples therapist, he or she may direct you to a sex therapist. Another good source is the American Association of Sexuality Educators, Counselors, and Therapists, an organization that certifies sex therapists (see "Resources"). Once you have a name, take the following steps to determine whether the person is a good match for you: Call the sex therapist. Some therapists will talk with you on the phone for 15 or 20 minutes about your needs as well as their philosophy and approach to treatment. Ask about the approach used, the frequency of sessions, the possible duration of therapy, and the fees involved. Be sure the therapist has extensive training and experience in working on sexual problems. Schedule a first visit. Having an initial meeting is not a commitment to ongoing therapy. Use the session to get to know the therapist and gauge whether you think you and your partner can benefit from working with him or her. If at all possible, both you and your partner should attend this meeting. |
Review Date: 2007-01-01
Harvard Medical School does not endorse products or services.
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