What To Expect...When You See a Sex Therapist

When people find out I'm a therapist, they usually nod and assume I am a massage therapist. Then I clarify: Actually, I am a sex therapist.

Cue the eyebrow arch. The pregnant silence. The look on their face as they file through the myriad of questions they want to ask in the moment but are second-guessing out of fear that it's inappropriate and I may not answer them. Or worse...maybe I will.

I once had someone ask me if I kept things like vibrators and dildos in my office. Someone else asked me if I showed videos to demonstrate sexual activities. I suppose it isn't surprising that not a lot of people know what a sex therapist does but I'm going to make it really easy for you. A sex therapist is like any other therapist. We just sought out additional training to talk about sex in greater depth and specialize in distress related to sex and sexuality.

To give you a better idea of what to expect when you're going to talk to a sex therapist, I will take you step-by-step all the way through to the end of the first, second, and maybe even the third appointment.

1. You understand the problem you have is something that a specialist needs to address.

If you have a medical condition that cannot be treated by your PCP, they will reasonably refer you out to a specialist. COPD? You need to see a pulmonologist. IBS? Gastroenterologist. Frequent UTIs? Might need to see a urologist or an OB/GYN. Mental health is really no different. You may start by seeing a therapist as you think it is depression, anxiety, or maybe a bit of trauma. What may prompt the therapist to refer to a sex therapist? If your chief complaint is directly related to your sexual health and functioning and you need interventions that are outside their scope of practice. Or the therapist themself is not comfortable with talking about sexual health. If someone came to me with a chief complaint of disordered eating, I would absolutely refer out as that is not my specialty. The same with Obsessive-Compulsive Disorder, personality disorders, and severe psychosis.

You may not be seeing a therapist but maybe Dr. Google has informed you that other people with similar experiences got help from a sex therapist. Some reasons people seek out sex therapy include:

• Intimacy Issues: Difficulty connecting emotionally or physically with a partner can lead to feelings of disconnection and dissatisfaction in a relationship. Sex therapy can help couples explore and address underlying issues affecting intimacy, such as communication barriers, past traumas, or differing sexual desires.

• Sexual Dysfunction: Problems such as erectile dysfunction, premature ejaculation, painful intercourse (dyspareunia), or difficulty achieving orgasm can significantly impact sexual satisfaction and self-esteem. Sex therapy can provide strategies, education, and support to address these issues and improve sexual function.

• Desire Discrepancy: Mismatches in sexual desire between partners can create tension and conflict in a relationship. Sex therapy can help couples navigate differences in libido, understand underlying causes, and explore ways to bridge the gap in desire.

• Communication Issues: Effective communication is essential for a healthy sexual relationship. Sex therapy can provide couples with tools and techniques to communicate openly and honestly about their sexual needs, desires, and boundaries.

• Past Trauma or Abuse: Individuals who have experienced past sexual trauma or abuse may struggle with intimacy, trust, and self-image. Sex therapy can offer a safe and supportive environment for processing trauma, rebuilding trust, and reclaiming a sense of sexual agency.

• Sexual Orientation or Identity Concerns: Exploring and affirming one's sexual orientation or gender identity can be a complex and deeply personal journey. Sex therapy can provide guidance, validation, and support to individuals navigating questions of identity, coming out, or negotiating relationships with partners and loved ones.

• Cultural or Religious Influences: Cultural or religious beliefs and values can shape an individual's attitudes towards sex and sexuality. Sex therapy can help individuals and couples reconcile conflicts between personal beliefs and desires, and explore ways to integrate sexuality into their lives in a way that feels authentic and fulfilling.

• Preparation for Major Life Transitions: Events such as marriage, childbirth, menopause, or aging can bring about changes in sexual function, desire, and satisfaction. Sex therapy can offer education, support, and coping strategies to navigate these transitions and maintain a satisfying sex life.

• Exploration of Sexual Pleasure and Satisfaction: Some individuals may seek sex therapy simply to explore and enhance their sexual pleasure, satisfaction, and fulfillment. Sex therapy can provide education, guidance, and practical techniques to help individuals and couples deepen their understanding of their own bodies and sexual desires.

• Prevention and Education: Sex therapy isn't just for addressing problems—it can also be a proactive means of maintaining sexual health and well-being. Sex therapists can provide education on topics such as sexual health, contraception, sexual consent, and healthy sexual practices, empowering individuals to make informed choices and foster satisfying sexual relationships.

The problems are different for everyone but the hesitation is almost universal. Then comes the next Google search for an actual sex therapist.

2. You've decided to start sex therapy. Now to find a sex therapist.

Whether you are looking for a therapist certified through the American Association for Sexuality Educators, Counselors, and Therapists (AASECT), looking on PsychologyToday.com, or just googling "sex therapists near me", it's important to look for a therapist that reflects your values and interests. If your faith is important to you, then starting with a therapist who specializes in undoing religious trauma might not be the best start to seeking help. Do you want your therapist to be a man or a woman? To support the LGBTQIA+ community? To be aligned with the support and safety of sex workers? To be virtual or in-person? There are a lot of questions to ask which will quickly shrink your list of choices that may be a good fit. Be sure your therapist is licensed in your state as there are many Life Coaches out there that blur the line between coaching and counseling. And if a therapist isn't licensed in your state, they cannot legally treat you. It may also be important to see if the therapist you're interested in has had any formal complaints against their license with their respective licensing boards. Also, some states require anyone looking to use the title "Sex Therapist" to undergo formal training before they can legally refer to themselves as such...like Florida.

And finally, do they accept your insurance? If not, how much do they charge and can you afford it...sustainably? Sexual distress can be as long-term as any other mental health concern so you may need to pay these fees for 3 to 6 months. Maybe longer in the event of trauma. Take the finances into consideration.

3. You've found a therapist who matches what you're looking for. Great! Time for outreach.

Unfortunately, the number of practicing mental health professionals is at a low and the number of sex therapists is even lower. This may mean long waitlists or therapists who say they are not accepting new patients at all. It may get discouraging but I urge you to keep trying. Once you connect with one, schedule a consultation. Most therapists offer free consultations, usually lasting about 15-minutes. As a therapist, I use this time to learn the short and sweet version of what brings this potential client to my proverbial door. Is it something I can help with or is it beyond my specific skill set? Does it feel like we vibe? Do they have any specific questions or concerns about what modalities I use or what my perspectives on certain topics? Big ones tend to be pornography, non-monogamy, and various kinks. If someone mentions trauma is a part of their chief complaint, I try to guide them away from getting too specific about the trauma in the consultation call, especially if they haven't worked on the trauma before with other therapists. If everything goes well, you hope your schedules are compatible to so you can schedule your first appointment.

4. What to expect between your consultation call and the first appointment.

Consents and intake paperwork. It might get overwhelming initially but this paperwork is really important no only because it saves precious time by not having to wait until the day of the appointment to fill it out but it also gives us permission to provide treatment. My paperwork reviews 7 major areas that are required to be reviewed and acknowledged prior to starting the therapeutic relationship.

• Consent to treat. You may think we're just talking but there is a reason we are licensed. There is a reason we've gone to grad school and had thousands of hours of supervised practice and then some. Our work is intended to make changes in your life and it's important to understand the benefits and the risks inherent to making those changes.

• Limits of Confidentiality. Therapists typically discuss the limits of confidentiality with clients, including situations where they may be legally or ethically obligated to breach confidentiality, such as if the client poses a risk of harm to themselves or others, or if there is suspected child or elder abuse.

• Finances. There are fees, whether you are a cash paying client or are using your insurance. It is important to understand what the fees are for, the amount of time you get in your session, how much of it is covered by your insurance company and whose responsibility it will be if insurance refuses to cover the service. There will often be a No Surprises form that goes along with this as well.

• Rights and Responsibilities. As a client, you have rights and responsibilities in psychotherapy which will be clearly stated in this particular form. As a therapist, I also have rights and responsibilities and these will also be laid out for you in this form.

• Telehealth & Technology. If you intend to meet with your therapist virtually, clients are typically required to provide consent for this format of treatment. This form outlines the risks and benefits of teletherapy, confidentiality considerations, technical requirements, and procedures for handling emergencies. If your therapist uses an EHR (electronic health records), secure messaging, emails, SMS text messages, or social media, you may be required to provide consent for the use of these technologies and acknowledge any associated risks to privacy and confidentiality.

• Release of Information. If clients wish to authorize the release of their confidential information to a third party, such as another healthcare provider or insurance company, they must sign a release of information form specifying the information to be disclosed and to whom it will be disclosed.

• Consent for Specific Treatment Modalities. If therapists plan to use specific treatment modalities or techniques (e.g., hypnosis, EMDR, exposure therapy), clients may be required to provide additional consent for these interventions. This ensures that clients are fully informed about the purpose, process, and potential risks of each modality.

I will also include a biopsychosocial to be completed which will briefly ask about your family history, current relationships, education, employment, military, medical history, substance use, religion/spirituality, social life/hobbies, trauma, and current legal stressors including any current probation or court-related involvement that may require me to provide a report. It's not intended to be exhaustive but it helps to highlight what is significant and contributing to the client's present stressors. Then this goes to your therapist who confirms insurance and payment details and also reviews your intake information prior to meeting with you.

There may also be one or all of the following assessments:
Patient Health Questionnaire-2: a two question assessment to screen for depressive disorders. (If you score 3 or above, you then get to take the 9 question version called the PHQ-9)
Generalized Anxiety Disorder-7 Scale: 7 question assessment to screen for anxiety disorders.

5. It's the date of your first appointment. Time for introductions and setting the tone!

This tends to be the most anxiety provoking moment for anyone coming to therapy for the first time but when it comes to sex therapy, people tend to be particularly nervous. We start with introductions and reviewing the previously signed consents to make sure there are no outstanding questions or concerns. Every therapist will have their own approach and their own style. This is how they establish rapport with you. A therapist needs you to relax and needs you to trust them and, to be honest, that may not happen right away. And we, as therapists, understand this.

When you arrive for your appointment, you'll be greeted by the therapist, who will likely invite you into a comfortable and private setting. The therapist will introduce themselves, explain their approach to therapy, and discuss the confidentiality of your sessions. This initial conversation is aimed at establishing rapport and helping you feel at ease. We will continue to ask questions, reflect, ask more questions, and while we are trying to conceptualize your case for ourselves we also attempt to get a better idea of how you view the problem as well. You may also notice that in the intake, I personally don't ask much, if anything, about sexual functioning before a patient arrives for their first appointment or even their second appointment. And this is very intentional.

6. Sharing Your Story

The heart of your first session will involve sharing your concerns, experiences, and goals related to your life with your sexual health as the primary focus. The therapist will encourage you to speak openly and honestly about your thoughts, feelings, and any challenges you may be facing. Remember, there's no judgment here – therapists are trained to create a safe and non-judgmental space for you to explore your concerns.

Depending on how much there is to review and share, we may have reached the end of the first appointment in which case we simply continue when we meet again. If this happens, my chief concern at the end of the first appointment is making sure you feel safe and heard and are confident about returning for your next appointment.

7. Assessment and Goal Setting. Now comes

To better understand your unique situation, the therapist may ask you questions about your sexual history, relationships, medical history, and any other relevant factors. This assessment helps them gain insight into your concerns and tailor their approach to best meet your needs. Together, you'll work to identify specific goals for therapy – whether it's improving communication with your partner, addressing sexual dysfunction, exploring your sexual identity, or something else entirely.

This assessment can also be very detailed depending on your chief concerns. Of course I won't push to discover information you don't feel comfortable sharing just yet but ultimately, the intention of taking a sexual health history is to be able to paint a detailed picture from the beginning of your sexual identity all the way through to the present. If something emerges during the assessment portion that exceeds the therapists skill set, they may discuss the need to refer to a specialist. This can happen in the case of forensic cases, where offending sexual behaviors occur, or where vulnerable populations may continue to be at risk. There is a subset of sex therapists who specialize in the risk assessment and treatment of legally offending behavior and it may be a necessity to secure the best outcomes for you and your loved ones.

8. Exploring Therapeutic Approaches.

Depending on your concerns and goals, the therapist may introduce various therapeutic techniques and exercises designed to help you navigate and address your sexual issues. These may include communication exercises, mindfulness techniques, sensate focus exercises, cognitive-behavioral strategies, and more. The therapist will collaborate with you to determine the most appropriate approach for your unique situation.

9. Building a Therapeutic Relationship.

Throughout your first session – and your ongoing therapy journey – the therapist will prioritize building a strong therapeutic relationship based on trust, respect, and empathy. They'll encourage open and honest communication, actively listen to your concerns, and provide guidance and support every step of the way.

10. Looking Ahead.

As your initial sessions come to a close, the therapist will discuss what to expect in future sessions and answer any questions you may have about the therapeutic process. They'll continue to work with you to schedule follow-up appointments and ensure that you feel comfortable and supported as you continue your journey towards sexual well-being.

And that's really all there is to seeing a sex therapist. We're just like regular therapists...only cooler.