Sex Therapy—What Is It and Who Needs It?

Sexual dysfunction of one sort or another is the issue I see most recurrently in my practice, although the reason why a client reaches out varies. Sometimes an individual’s tolerance level peaks, and they finally decide to do something about an issue that may have been smoldering for years. Sometimes it’s a partner who brings in their proverbially “broken” partner, telling me to “fix it.”

Couples often seek sex therapy together, as sexual problems tend to be more obvious within relationships. However, by the time the couple comes for therapy, the issues have most likely been plaguing them for some time. The relationship often comes close to ending before the couple agrees to address the problem. For example: Say a guy brings his wife because she’s “frigid,” whatever that may entail. They’ve been married for X-number of years, and he’s finally had it. She, on the other hand, doesn’t want to be in therapy, because she doesn’t really think there’s anything wrong with her. She just doesn’t want to have sex anymore, and she doesn’t want to discuss it. Period.

This is a difficult way to start therapy. Resentments are high and frustrations rage. If the couple does continue, we usualy discover that there’s also something desperately wrong with the husband. Inevitably, we ascertain that he’s an ineffectual lover—and his inability to pleasure his wife is the root of her “problem.” It’s often painfully clear that he knows little (if anything) about his wife’s sexual needs or wants. Meanwhile, the wife has never had permission to know her body, so she’s unable to help or direct him. As you can imagine in a case like this, there’s a load of remedial sex education that must come before anything else is resolved.

Couples also seek therapy when one spouse has cheated on the other. The “cheat-ee” declares, in no uncertain terms, that this therapy is the last-ditch effort before “the end of the road.” Often in such cases, it’s too late for a successful intervention, because each partner is so angry and shamed that the chance of turning the situation around is slim. Sometimes the best we can do is end the relationship with as little acrimony as possible.

In difficult couple counseling situations like this, my first effort is to get the couple to disarm. There will be no sex therapy—and God knows there is a need for sex therapy—until there is some semblance of peace between partners. If we don’t establish at least a small bank of goodwill, our efforts are doomed.

Of course, there are plenty of individuals—and couples—who haven’t waited until the last minute to seek help. These people want to be proactive about their concerns. Some people simply need some clear, unambiguous information about human sexuality. A surprising number of people are trying to piece together their sexual lives, but are hampered by misconceptions and misinformation.

Sometimes a traumatic event motivates a person to address arising sexual or intimacy issues. A disease process, a death in the family, or an accident can fundamentally alter the power dynamic of a relationship, which will require a rethinking of the entire relationship.

Or perhaps someone comes to a new realization about him or herself: Perhaps they are finally able to acknowledge their bisexuality, or that he’s gay, or she’s a lesbian. Maybe they are finally able to acknowledge a fetish—he’s a crossdresser, or she’s into another kink. Things like this obviously impact the individual, but if that person is in a relationship, the relationship is also affected. People in these self-revelatory situations are often unsure how to talk about their discoveries with a partner, which is another reason they seek counseling.

Some couples don’t fret when the sex vanishes from the relationship; other couples are devastated. What does one do when one partner still has sexual needs, but the other doesn’t? Often, there are unexplored options that can hold the relationship together, but will address the disparity in sexual interest and desire.

In this case, I can help the couple make compromises without losing their moral compass. Some couples navigate this with ease; others not so much. It can be extremely challenging, but there are ways to preserve what’s sacred about a primary relationship, while contemplating opening the relationship to include others. I can help a couple establish guidelines and ground rules for making the necessary adjustments.

Sometimes the relationship is really wonderful and fun. The couple really loves each other, but they’ve noticed their sex life together is pretty boring. I’m often approached to simply help a couple spice things up. In this instance, my work is sheer joy. Mostly, I just give them permission to experiment and have fun.

You’ve probably noticed that a good portion of the work that I do as a sex therapist is merely giving permission. That may not sound like therapy at all, but when you consider that our sex-negative culture is so full of prohibitions; permission giving is often the front line of sexual rehabilitation. Most of the permissions I give are for an individual to educate him or herself about his or her body and his or her sexual response cycle. Personal exploration, such as masturbation, is the very best means to that education. I’m a huge proponent of partners masturbating together.

Happily, our need to reacquaint and reeducate ourselves about our bodies and our sexual response cycle is a life-long process. There is always something new to explore. As we age, our bodies change, and if we don’t keep up with those changes, we can become frustrated and disoriented. Older people, menopausal women and andropausal men, take longer to build up “a head of sexual steam.” If you’re not attuned to the changes you are going through, you can easily miss the important cues your body is sending to slow down and enjoy the sensuality.

Of course, I could go on and on, but now I want to leave you with what is the distillation of years my thinking about the role sexuality plays in our life:

I believe that sex is like food. We can enjoy it alone, or with others. We can be abstemious, or gluttonous. We can nosh or nibble; dine or devour. And we can be certain there will be both times of feast and famine.

Sex is like food. It can nourish and sustain us, or it can make us sick. We can consume all the available bounty, or restrict our diet. It can completely satisfy, or leave us devastatingly empty. We can employ it to express our highest aspirations, or allow it to rob us of our soul. We can give it as a gift, or use it as a weapon. It can be both bacchanal and sacrament.

One thing is for sure, whether purely physical or transcendentally spiritual, no one can live without food…or sex.


Dr. Dick is an author, speaker and licensed sex therapist. To learn more or to hear his podcasts, visit DrDickSexAdvice.com.