Sex therapy: is it for you?

by Elaine Gottlieb

These days, many couples find it hard to fit sex into their busy schedules. And it's perfectly normal for people to go through periods when they're just not in the mood for love making.

But if you chronically lack desire for sex for emotional or physical reasons you may want to consider sex therapy. Seeking treatment for sex problems has become more socially acceptable today, but it's still not easy for many people to talk to a professional about such an intimate concern.

"There are probably a lot of people out there who could use therapy but don't come because they're embarrassed. They may go through years of needless pain or dissatisfaction," says Alexandra Myles, M.S.W., a sex therapist at McLean Hospital in Belmont, Massachusetts, and in private practice.

Before you decide to see a sex therapist, take the time to explore whether it is really what you need. Myles and other therapists recommend that you:

See a doctor, particularly if your problem is physical in nature. A gynecologist or urologist can detect difficulties due to illness, aging, or metabolic and hormonal imbalances. Prescription drugs, non-prescription drugs, alcohol, and smoking can all affect sexual functioning, according to Judy Seifer, Ph.D., a certified sex therapist and clinical professor at Wright State University in Dayton, Ohio.

Learn more about sexuality. In spite of the greater openness about sexuality today, many people have little understanding of their own bodies and sexual functioning. Informational and self-help books and educational sex videos, which are widely available, can be very helpful (see Resources section). Becoming better informed will help you decide whether you really need therapy; some people, in fact, are able to solve their own problems through self-help guides.

Many people come to sex therapy after individual psychotherapy fails to help them with their sexual problems. Masters and Johnson, the pioneers of sex therapy, discovered back in the 1950s that talking alone wasn't enough to resolve sexual issues.

"The obvious thing is that you're dealing with the human body so you can't just talk about how you feel; you've got to work on the physical level as well," says Myles. Sex therapy generally address the emotional issues underlying sexual problems and employs behavioral techniques to deal with the physical symptoms.

These behavioral techniques involve physical exercises that clients do on their own outside of the therapy setting. "Nothing should happen in the therapist's office of a sexual or physical nature," Myles emphasizes. (Sex therapists should not be confused with sexual surrogates, who do engage in sexual relations with clients. They are only licensed in certain states and are becoming less popular due to AIDS.)

One popular technique used in treating many sexual problems is called sensate focus, in which couples caress or massage each other without sexual contact. The goal is to help both partners learn to give and receive pleasure and feel safe together. As the partners become more comfortable, they can progress to genital stimulation.

As a result of performing this exercise, many couples discover new ways to experience pleasure other than sexual intercourse. "Some of my patients find that they become better lovers," says Dennis Sugrue, Ph.D., a sex therapist at the Henry Ford Behavioral Services Program in West Bloomfield, Michigan.

Other exercises treat specific problems such as women's inability to have orgasms and men's erectile problems. Common complaints like these can usually be resolved in two months to a year of treatment, therapists report.

Performing these exercises often evokes strong feelings that are then explored through psychotherapy. People who have experienced sexual trauma or are confused about their sexual identity may need to spend more time working through their feelings. For couples, who make up the majority of clients, the focus is on improving communication and developing greater intimacy.

When looking for a sex therapist, it's critical to find a practitioner with the proper credentials to deal with this sensitive subject area. A sex therapist should be an experienced psychotherapist (licensed social worker, psychologist, psychiatrist, or psychiatric nurse) with training in sex therapy from a reputable program, such as those offered by teaching hospitals or institutes.

These programs include instruction in sexual and reproductive anatomy and treatment methods. Other topics covered include sexual abuse, gender-related issues, and sociocultural factors in sexual values and behavior.

Sex therapists can become certified through the American Association of Sex Educators, Counselors, and Therapists (AASECT). Certified therapists must meet rigorous requirements and adhere to a strict code of ethics.

You can obtain referrals for sex therapists from AASECT and other professional organizations such as the National Association of Social Workers and the American Psychological Association. (See Organizations listing below for contact information.) or ask your primary care physician, gynecologist, urologist, or therapist.

In looking for a sex therapist, it's particularly important to find someone whom you trust, respect, and with whom you share compatible values. Don't be afraid to ask questions about the therapist's background, philosophical orientation, and client-related experience with your problem.

A sex therapist can be very influential, says Gina Ogden, a certified sex therapist in Cambridge, Massachusetts and author of Women Who Love Sex, because "there are fewer people who you can talk with about your sexual issues." She warns against therapists who have rigid ideas of what human sexual response should be. Myles agrees: "Sex is such a subjective experience. You can't impose your own beliefs on a patient."

If you see a therapist who says or does anything suggestive, or that involves nudity, terminate the relationship immediately. "Sex therapy is strictly talk therapy. There should be no 'show and tell'," asserts Seifer, a former president of AASECT.

Most sex therapists today, according to Dennis Sugrue, "look at the whole person and try to help men and women redefine what it means to make love." The effects of aging or physical problems "don't mean that a couple can't experience the pleasure and joy of being physically intimate with each other."