Let's Talk About Sex
When thinking of counseling services, sex therapy might not be the first that comes to mind, and it may, in fact, feel taboo to talk about. Yet, it’s a service that can help various aspects of life and personal well-being.
But not all sex therapists are created equal. Marilyn Lawrence is a certified sexologist by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). Lawrence explains in a Men’s Journal article that a person can go to a sex therapy workshop and get a “certificate,” but that does not mean the person is certified. For the best experience, she recommends therapists certified by AASECT, the Institute for the Advancement of Human Sexuality or the American College of Sexologists.
Once a good sex therapist is locked down, it’s up to the client to be open and honest.
Claire Postl, a certified sex therapist at the Ohio State University Wexner Medical Center, recognizes it can be challenging to approach the subject. She says clients may have fears confronting a person who perhaps knows more about sex than them because of an intrinsic bashfulness.
“[The client] maybe will feel inadequate going into sex therapy, but it’s important to realize everyone has sexuality, including your therapist,” Postl says.
In sum, a sex therapist is not there to judge.
Lawrence admits that there will be initial discomfort, and clients have to be prepared for that. Therapy will not work if the client isn’t ready to talk. Postl adds that sex therapy is very similar to a typical therapy session. Because there is often a correlation between mental health and sexual health, a lot of sex therapy treatments used are based on mental health therapy practices.
“It’s a very similar atmosphere. There’s often a connection between mental health and sexual health. So, we try to work through those anxieties and break down those barriers,” Postl says.
While some may think that sex therapy caters toward older people or couples, Postl insists that it includes everyone, couples and singles, from ages 20 to 70. For example, Postl finds her college-aged clients may have erectile dysfunction or premature ejaculation. But there is no key demographic— those issues can arise for anyone.
For college students, Postl says, there is often a misconception that an erection has to lead to intercourse. She says people tend to cut out the middle man (i.e oral sex and kissing) and “put intercourse as the end-all-be-all.”
However, Postl argues people should be able “to flex” what happens. Foreplay doesn’t always have to lead to sex. That is where a lot of pressure, particularly for males, comes in. Foreplay can focus more on intimacy and connection if the person chooses.
Laurie Watson, a certified sex therapist and host of "Foreplay," a sex therapy podcast, says that the first sex therapy session is focused about what’s hurting the client. Therapists often delve into a patient’s medical and sexual history, childhood and current relationship status during those preliminaries.
If there’s one misconception that Postl would like to dismiss, it’s that there is physical contact between the therapist and the patient.
“I have been confused for a sex worker, which there is nothing wrong with sex work, but that is completely false,” Postl says. “No one gets naked in my office. Unlike a health clinic, no one will show me their genitals.”
Watson says patients should speak up if they feel uncomfortable or if their sex therapist shows a lack of professionalism.
Using different models of sex therapy, sexologists will often assign “homework” to patients. This could include experimentation, such as role-playing, using sex toys or switching up positions. Health considerations could be taken at that stage.
A common sex therapy technique called sensate focus is often used to reduce anxiety and increase communication with couples.
The three-step process starts with nonsexual touching, which progresses to genital touching and penetration. Postl says the model is about mindful sex and appreciating sensation and stimulation.
Postl says a cognitive approach can also be beneficial when addressing anxieties. Cognitive approaches make clients view themselves as a learner willing to have patience. Therapists may also employ a variety of communication strategies to be applied at home or assign a good old reading to further educate their clients.
The length of sex therapy varies for each person and their problems. Sexually focused problems such as dissatisfaction or climax difficulties typically take two sessions or less according to Watson. Though, Postl argues issues such as erectile dysfunction can have a systemic root that requires more work.
Watson says issues related to relationship strain that lead to sexual discord could lead to up to six months of sessions, including couples therapy. Sessions relating to trauma-induced anxiety and stress last as long as the patient needs. Postl usually sees college students for one or two sessions.
“I love working with college students the most,” Postl says. “It is the biggest period of sexual development, the biggest peak in exploring sexuality and a pivotal point in sexual life. Being able to learn healthy sexual practices early on is so important.”