Over the past few years, I’ve been invited to speak with graduate counseling programs in the Seattle area about two topics that students are often deeply curious about: what it takes to become a sex therapist, and how different theoretical approaches to couples therapy actually play out in real clinical practice.
Most recently, I joined a Family Systems and Couples Counseling class at Bastyr University’s Kenmore campus as part of a guest panel for emerging therapists. The goal, as the course instructor put it, was to give students “a deeper understanding of the clinical realities of working with sexuality in therapy.”
I appreciated that framing. Sexuality and relational dynamics are central to many clients’ lives, yet they’re often underemphasized in graduate training. Students want clarity. They want honesty. They want to know what the work really looks like.
Becoming a Sex Therapist: Training, Scope, and Responsibility
One major focus of the discussion was what it means to become a sex therapist. Students asked about formal training pathways, certification standards, supervision requirements, and how to ethically expand into this specialty area.
Sex therapy is not simply about being comfortable talking about sex. It requires education in sexual development, sexual health, desire discrepancies, relational dynamics, trauma-informed care, and cultural humility. As a Certified Sex Therapist (CST), I emphasized that ethical practice involves understanding when concerns are relational, psychological, medical, or some combination of all three.
Students were especially curious about what issues actually show up in sex therapy. In practice, concerns often include:
- Desire discrepancy in long-term relationships
- Low desire and sexual avoidance
- Performance anxiety and erection concerns
- Orgasm difficulty
- Shame and sexual self-concept
- Sex after betrayal or rupture
- Navigating communication, consent, and initiation
For many couples, sexual distress is less about technique and more about safety, pressure, and emotional connection. If you’re curious about how this work unfolds in practice, you can learn more about our Sex & Intimacy Therapy services.
Theoretical Approaches to Couples Therapy in Real Life
The second theme that generated strong discussion was theoretical orientation. Students often learn multiple frameworks — family systems theory, attachment theory, emotionally focused therapy, the Gottman Method, cognitive-behavioral approaches — but it can be difficult to imagine how those models translate into moment-to-moment decisions in the therapy room.
As a Certified Gottman Therapist who also works from attachment and systems perspectives, I shared how models provide structure, but the therapist’s steadiness is what makes the work effective. Recognizing a pursuer-withdrawer pattern is important. Helping partners slow that pattern in real time requires emotional regulation, pacing, and careful intervention.
In couples therapy, we’re often helping partners move from blame toward vulnerability, from defensiveness toward curiosity, from pressure toward collaborative problem-solving. That shift doesn’t happen through theory alone — it happens through guided emotional experience.
I’ve written elsewhere about relational dynamics such as how desire often follows initiative, and conversations like these are often eye-opening for clinicians-in-training who are beginning to see how sexual and relational concerns overlap.
The Emotional Reality of This Work
Students also asked a more personal question: what is it like to be a sex therapist?
The honest answer is that it’s meaningful, complex, and sometimes demanding. Sexuality carries vulnerability, history, identity, and sometimes shame. Couples therapy carries intensity, conflict, and longing. The work requires steadiness and ongoing consultation.
Over the years, growing Clarity Counseling Seattle from a solo practice into a long-standing group practice has reinforced something I shared with the students: sustainable relational work depends on clarity, boundaries, collaboration, and continued learning. I’ve written more about that evolution in Clarity’s journey from solo to group practice.
Why Graduate Conversations Like This Matter
Therapy training programs cannot cover everything in depth. Panels and guest lectures offer students a chance to ask nuanced questions in a practical, unscripted way. When future clinicians feel more prepared to talk about sexuality and relational dynamics with confidence and professionalism, clients ultimately benefit.
Being invited to speak with graduate programs in the Seattle area is one way I stay connected to the broader clinical community and contribute to the next generation of therapists.
If You’re Seeking Couples or Sex Therapy
Clarity Counseling Seattle provides relationship-focused therapy and sex therapy for individuals and couples throughout Washington State. If you’d like to learn more about working with a Seattle couples therapist or explore support for sexual and relational concerns, our services pages offer more detail about how we approach this work.
And if you’re a clinician early in your career: curiosity, humility, and strong supervision matter more than having all the answers. Relational and sexual therapy are learned over time, through training, experience, and thoughtful reflection.