When Is It Time to See a Sex Therapist?

Sexless marriage, infidelity or just wanting to spice things up, here's what you need to know about seeing a sex therapist

Ellen Uzelac,

AARP

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Published December 26, 2024

Kiersten Essenpreis

I wish my late husband and I had explored sex therapy during our 20-year relationship. Like any other couple, we faced some intimacy challenges — my plummeting libido when I entered menopause, his lack of stamina after lung disease took hold.

I now know these are fairly common issues that sex therapists can help couples work through. In this week's column, our sexuality experts spell out the main reasons 50-plus adults seek out a sex therapist, what to expect in a session, and how to know when it should be your next move.

Under what circumstances should a couple consider seeing a sex therapist and what issues are they trained to resolve? Also, how do you identify one who is qualified and professional?

The toughest part of sex therapy is often just setting up the appointment and walking through that door for the first time, according to certified sex therapist Chris F. Fariello.

As Fariello frames it: "When couples come to us, they’re often desperate for some relief. Once in the room, they recognize that they need us — and that we can help."

How to know it's time to see a sex therapist

If you and your partner have tried to work on an intimacy issue and are unable to resolve it, a therapist can help, says certified sex therapist Emily Jamea.

And, there's no shame in not knowing how to fix it; it's a topic most people don’t know how to approach. “There's not a lot of education or role modeling on how to talk through sexual issues” as couples, says Jamea, author of Anatomy of Desire: Five Secrets to Create Connection and Cultivate Passion. "Sex therapists are trained to facilitate a conversation around that."

The usual issues that drive couples into sex therapy

Prepare yourself. It's a long list.

Desire discrepancy — where one person has more sexual desire than the other — is the No. 1 reason Fariello finds couples in his office.

Other issues that therapists are trained to address, Fariello says:

sexual dysfunction such as premature ejaculation and erectile dysfunction
infidelity
compulsive sexual behavior
figuring out sexual orientation
introducing kink
interest in polyamory
open relationships outside of monogamy

Working through feelings plays a big part

Licensed clinical psychologist Rachel Needle says therapists help clients work through their emotions, often collaborating with other health care providers if medical or physical factors are involved.

How do you talk to a stranger about something as personal as your sex life?

Sex therapists are trained to pick up on how quickly or slowly a client is comfortable opening up, Jamea says.

"We know it's a really sensitive topic for people." Some are ready to lay it all out there, she says, while others might need a few sessions with a therapist to establish rapport and build trust.

Even though many of the clients Fariello sees have never spoken about sex to anyone, he says they tend to open up pretty quickly.

"We're not scary for them," says Fariello, founder of the Philadelphia Institute for Individual, Relational & Sex Therapy. "We ask questions in nonjudgmental ways and build a safe space."

More 50+ Sex Advice

Fariello says clients have told him, "God, I’ve never said these words before" and "I'm embarrassed to say this out loud."

"We validate their feelings and normalize their experiences."

What are the sessions like?

Typically, a therapist meets with a couple together, followed by solo sessions with each partner, Fariello says.

"We're looking to assess how the couple works together, their strengths, challenges and hopes," he notes.

Often during the fourth session, the couple and their therapist discuss specific goals and review a general treatment plan. After that, Fariello says, the couple meets weekly for a 50-minute session for as long as three to six months.

Therapy goes faster the more work you do out of the room. And what kind of work? Fariello says many therapists provide exercises around communication and conflict resolution that can be practiced at home.

How do you find a good sex therapist?

First, what not to do. A lot of people go online, search for “sex therapist near me” and websites show up promoting local professionals — many of whom have “zero” training in sexuality, according to Fariello.

What certifications they should have. What you’re looking for is a sex therapist who has been certified by the American Association of Sexuality Educators, Counselors and Therapists, the gold standard when it comes to training and certifying sexual health professionals.

To even begin AASECT training as a certified sex therapist, the person must already be a licensed mental health practitioner such as a psychologist, licensed social worker, marriage and family therapist, or counseling professional. To become certified, therapists must have a minimum of 300 hours of clinical experience with clients and 50 hours of sex therapy supervision.

Find a therapist that is right for you and your partner. Fariello suggests that you go to AASECT.org. and click on the "Find a Professional" tab, where you’ll be able to search for certified sex therapists by country and state. Listings include contact information, academic degrees, professional titles and areas of specialization.

Jamea says to look for a therapist whose focus — desire discrepancy or sexual dysfunction, for example — aligns with the issues you want to work on.

Also, be aware that not all certified sex therapists are trained to treat couples. Be sure yours is.

There should be no touching. Sex therapy is not well understood, Jamea concedes. Some people think sex therapy is hands on; it is not.

"We would lose our license if we ever touched a client," she says, adding that many people assume a sex therapist is going to encourage them to do "all kinds of kinky things." "Nothing could be further from the truth," she says.

The bottom line

Seeing a sex therapist can help couples rekindle their relationship. "I see results every day. It’s why I do the work I do," Jamea says. "Sexuality is a fundamental part of being human. There's so much beauty and wonder in it. I see transformations all the time."

Do you have questions about sex or relationships as a 50-plus adult? Send them to sexafter50@aarp.org.

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