Our practice often receives inquiries from folks asking about the need for their individual or couples therapist to be specifically trained in sex/intimacy issues. This is certainly understandable considering the relative few fully-trained sex therapists as compared to therapists without this specialty, especially in a city like Seattle which has a great number of licensed and able therapists. Those of us trained in sex & intimacy issues (up to and including low sex drive, sexless marriages, mismatched sexual desire between partners, etc) are more difficult to find, to book sessions with, and we often charge more money. Plus, shouldn’t clients assume that any counselor claiming qualifications to work with relationships be ready to help address relational sexual distress?
Sex Therapy Education
Unfortunately, the educational programs we therapists attend simply don’t have the ability to train us fully on sex/intimacy-related issues, not without doubling the time we would spend in graduate school. So only some of us come to recognize the importance of becoming well-versed in matters of sex and sexuality, taking on the daunting, expensive, and laborious road toward licensure through The American Association of Sex Educators, Counselors, and Therapists (AASECT) which has very stringent requirements for training and experience in the area of sex therapy. Sexual health professionals have rigorous standards for academic preparation, supervised training and consultation, field-related experience and applied skills. Sex therapists becoming properly trained must read a great deal of academic books, attend many (many!) hours of clinical trainings and workshops in this specialty, do peer consultation, and study under seasoned clinicians who are considered masters in this field. Upon embarking on AASECT sex therapy certification, many competent and impactful therapists report their disbelief and humility at how much they actually didn’t know about their client’s sex-related issues and how to help with them.
Issues to Address with a Sex Therapist
It’s worth clarifying which issues are commonly considered within the domain of qualified sex therapists. Individuals and couples often seek us out for the following concerns:
- Low or no sexual desire or drive
- Sexless marriages
- Frequency disagreement between partners
- Women who want to have their first orgasm; or want to orgasm with their partner
- Men with premature ejaculation
- Erectile dysfunction
- Delayed ejaculation
- Breast cancer and prostate cancer survivors
- Talking about sex
- Technique problems
- Learning to enjoy oral sex
- Getting over the “ick” factor feelings about different sex acts
- Porn addiction or sex addiction
- Sex has become boring
- Not attracted to their partner or mismatched sexual desire between partners
- Arousal difficulty
- Inhibitions of all sorts
Additional Issues to Discuss With Sex Therapist
Furthermore, the kinds of sexual issues that concern the men and women who enter therapy may be even broader than what the tend to think of as sex therapist -necessary concerns: wanting greater partnership, safety, spiritual fulfillment, fun, a sense of aliveness, and an opportunity to triumph over past experience (e.g., childhood sexual abuse). Non-sex therapy trained clinicians may not be prepared to help their clients with some of the intricacies and complexities of these concerns.
Something very useful found within sex therapy is what we call the PLISSIT model, which is used to determine the different levels of intervention needed for each client. The letters of the name refer to the four different levels of intervention that we can apply: permission (P), limited information (LI), specific suggestions (SS), and intensive therapy (IT). The varying levels largely revolve around what the client is looking for and how comfortable they are in discussing sexuality and sexual health.
- The first level is permission, which involves the sex therapist giving the client permission to feel comfortable about a topic or permission to change their lifestyle or to get medical assistance. This level was created because many clients only require permission to speak and voice their concerns about sexual issues in order to understand and move past them, often without needing the other levels of the model. The sex therapist, acting as a receptive, nonjudgmental listening partner, allows the client to discuss matters that would otherwise be too embarrassing for the individual to discuss, either with a professional or with their partner. Unfortunately, some therapists without specific training in sex and intimacy issues are uncomfortable with their ability to help clients with such issues, thereby avoiding related topics altogether or at least giving the impression to clients that they may not have permission to bring such matters into the therapeutic work.
- The second level is limited information, wherein the client is supplied with specific information on the topics of discussion. Often individuals and couples are simply lacking appropriate, relevant, or accurate information about sex-related challenges. This is certainly exacerbated by an American culture that fails to adequately educate children and adults around issues of sexual health. The vast store of information accumulated over decades of sex therapy research and treatment is made available to qualified sex therapists, resources of which therapists not trained specifically in sex therapy often remain unaware.
- The third level is specific suggestions, where the sex therapist gives the client suggestions related to the specific situations and assignments to do in order to help the client fix the mental or health problem. This can include suggestions on how to deal with sex-related diseases or information on how to better achieve sexual satisfaction by the client changing their sexual behavior. Here again, the sex expert is better equipped than other therapists to prescribe specific exercises, regimens, activities, or even medications.
- The fourth and final level is intensive therapy, in which sex therapists are adequately trained to extend therapy considerably deeper to deal with underlying issues. If necessary, a referral can be made to other appropriate sexual health specialists such as pelvic floor specialists or urologists trained in sexual health.
Profound Change for Couples and Individuals
Sexual problems can provide opportunities to aim for profound change for the individual or the couple. Those of us specifically and thoroughly trained to treat sexual issues in psychotherapy can help our clients attain insight; increase self-esteem; improve body-image; and experience pleasure, intimacy, joy connection, erotic potential, empowerment, mutual resonance, and ecstasy. Sex therapists often see themselves as playing a critical role in preventing rather than simply treating sexual problems, using our training in this discipline to provide resistance to those beliefs and attitudes which generate sexual difficulties. Armed with the skills, knowledge, and tools accumulated through the certification process and beyond, therapists specializing in issues of sex and intimacy are uniquely equipped to provide individuals and couples with opportunities to aim for profound change.