• We asked two certified psychosexual therapists to bust some myths and answer some FAQs
• “If a sexual difficulty is causing you distress, it’s better to get it sorted and stop the problem snowballing”
Sexual difficulties like erectile dysfunction are often symptoms of underlying psychological issues, and psychosexual therapy — to give it its real name — can be an effective way to start dealing with them.
Statistics suggest it works — a University of Pennsylvania study found that 65% of couples who sought sex therapy reported positive results, while the majority of those that didn’t had a reason involving illness. A Brazilian study into ED treatments found that a combination of drugs and therapy could be up to twice as effective as drug use alone.
But the prospect of it can seem daunting.
It feels like it could be anything from an incredibly noncommittal chat (“Do you like sex?” “Yes”) to someone... surely not... guiding you in? (No. Psychosexual therapy is based around talking and involves no physical contact — that’s porn giving you the wrong idea.)
Everyone should feel able to seek the help they need, so Numan asked two psychosexual therapists to demystify ‘sex therapy’ and answer a few of the questions potential patients might have.
When should I seek therapy?
Kate If symptoms persist for six months or a sexual difficulty is repeatedly occurring, dealing with it sooner rather than later is preferable. The best time to seek psychosexual therapy is before the problem becomes too ingrained, but people rarely do — most seek psychosexual therapy in response to some kind of trigger event. If a sexual difficulty is causing you distress, it’s better to get it sorted to alleviate that stress and stop the problem snowballing.
Selena Men will present with erectile problems, premature ejaculation, delayed ejaculation. People have concerns about their sexuality, or anxieties around paraphilias — their own or their partner’s. Sometimes there can be obsessive-compulsive issues around hygiene, libido issues caused by depression, side-effects caused by medication…
Where/how do I find a therapist?
Kate The best way of finding a psychosexual therapist is through the accrediting body College of Sexual and Relationship Therapists (COSRT).
Do I go on my own or with a partner?
Selena If you’re in a relationship, I try to see both partners. You don’t want to stigmatise one person. It’s important that the problem is owned by the couple and that the relationship is the client. If one partner has an issue and the other is saying, “What’s wrong with you?” then that’s not helpful. Seeing both partners means I can talk about their responses and how they can be helpful.
How does it start?
Kate Therapy will typically start with an assessment process or appointment to determine the best course of action and put a clearer picture in place. For example, if the therapist suspects there may be a physical cause for symptoms, there may be a referral to a GP to ensure best practice and the best treatment plan. After assessment, the therapist will discuss a treatment plan, the therapy process and what you hope to get out of your sessions.
Selena You don’t want to be treating it from a psychological point of view if there’s a physical problem, like a hormonal issue or physical block. Depending on what someone’s condition is, even if it isn’t a physical issue, I might refer them on — there are people that specialise in paraphilias or sexual compulsivity, for instance. If there’s a mental health issue that needs to be addressed in the first instance, I might refer someone on to a mental health specialist.
Do they ease you in? What if I’m nervous?
Selena The first session is very much about building a relationship, and while pretty much everyone is nervous at the beginning, by the end of the session they are much more at ease.
Sometimes people have had a negative experience with a GP or nurse being unable to help with their problem and are relieved to be able to talk to someone who’s listening to them and is at ease with the subject.
How long are sessions?
Kate Appointments are typically 50 minutes weekly. There may also be some exercises for you to do at home between sessions, either as an individual or a couple.
Do I have to tell the therapist everything about my sex life?
Selena It’s all on a need-to-know basis. I will ask some standard questions — for instance, I’ll ask about alcohol and drug use, because that is extremely relevant. I’m not going to ask people about sexual trauma or child sexual abuse or anything like that — they may disclose it, but I’m not going to ask for details because that could re-traumatise them. They might volunteer the details, but that’s up to them.
Sometimes people are worried about disclosing their sexual fantasies, particularly if they’re bizarre or illegal. But, the vast majority of people don’t want to act on them — they’re just that — fantasies to aid arousal. We make it very clear that this information is confidential — the only times we are ever legally obliged to disclose information to the police is if it involves terrorism or money laundering.
What does a typical session involve?
Kate Sessions may involve talking elements of sexual education and tackling myths. You may explore beliefs with your therapist, challenging negative thoughts or anxieties about sex alongside developing sexual self-awareness. There may also be some exercises to be done by the person as an individual or as a couple at home.
Selena Sometimes we do anatomy and physiology — there are things that people just don’t know. I had a client who was a lawyer in her thirties who had two children and just knew nothing about her genitals. There are some cultures where certain subjects aren’t really discussed and people end up not really knowing which hole is which.
What’s the vibe? Will I be lying on a chaise lounge?
Selena It’s a quiet counselling room. There are usually a few chairs and a couch so there’s plenty of space to see couples. And by couch I mean a settee, not a Freudian couch.
How many sessions should I have?
Kate Each case is unique and there is no way of answering or knowing how long a therapy process will take. Therapy can be transformative for many, but it is a process, not a magic wand. Some people are able to overcome their challenge in a short number of sessions, for others it may take longer. Like most processes, it is often the case that what you put in you get back out. The sessions can be treated as a catalyst for changing things in people’s sex lives and relationships but there is also input and work required outside the sessions.
Selena I let the client decide. Sometimes I’ll say I think we’ve reached the goal we set out to reach, but these things can be very variable. It’s impossible to say.
Do I have to take my clothes off?
Kate No. Psychosexual therapy is purely a talking therapy, so there is no removing of clothes, touching or contact other than talking between the client and the therapist.
Selena Absolutely not!