What Brings Clients Into Sex Therapy?

Author: Anne Mathews

At the risk of stating the obvious the answer to this is because their sexual relationship is not working. This then begs another question. Why is it not working? At this point I get curious about which is “chicken” and which is “egg” i.e., are the difficulties in the sexual relationship due to the problems with sex itself or in fact does the answer to the problem lie within the relationship e.g., how do the couple manage to resolve conflict?

What is the “fighting style” of the couple? Do they avoid dealing with issues that arise within the relationship, which could lead to conflict? These issues then may be “brushed under the carpet”. If arguments do happen does one member of the couple “have to win”. Does one member want to deal with issues and the other walks away? All of these scenarios can lead to underlying resentment, which in turn will affect the sexual intimacy of the couple.

There are gender issues that need to be considered e.g., most men need sex to feel close to their partner and women are the opposite. Women need to feel emotionally connected to their partner in order to be sexual. So, for women if sex is to happen it may depend on how their partner interacts with them in other areas of the relationship e.g., are their opinions heard and valued? For men, if sex is not happening, they can feel isolated and disconnected. Although through my experience of the work there are times when this dynamic is the opposite in some relationships.

In any couple’s relationship there are issues around power. Who has it and who is perceived not to have any? Sometimes the partner who is perceived not to have any power in other areas of the relationship can hold the power around when and if sex happens or it does not.

For sex to work well, both couples need to be getting their sexual needs met. Very often couples find it difficult to talk to each other about the sex. Indeed, very often individuals have not identified what their own sexual needs are, and yet may have expectations of their partner, which are unspoken. This can then lead to a misunderstanding and disappointment with the partner because they are not able “to bring them to orgasm”. Part of the work is the awareness that each of us is responsible for our own orgasm.

I believe that for sex to be desired it has to be desirable. This can only come about through communication. This can be verbal or nonverbal. If you find words difficult show your partner what works for you. In order for sex to happen at all sexual dates may have to be the order of the day. There is a myth that the best sex is spontaneous.

Part of the challenge in long-term relationships is keeping sex a vital part of the couple’s intimacy. This can take a bit of planning but unless it is given a space and is a priority it can fall off the radar. The time can be absorbed into families, work and other activities. So, time must be set aside because if not the couple can quickly end up in a “sexless marriage”. A sexless marriage can be defined as a relationship where sex happens less than ten times a year.

There is what can be referred to as “pinch points” within a relationship. These are natural milestones that every relationship has to work through e.g., having a baby, losing a parent or losing a job. Financial and work place stresses also take their toll on a couple’s relationship. At these times desire can be low and sex can be avoided. This then can become the status quo within the relationship. This lack of sexual activity can lead to partners, usually the man, turning to the Internet or cybersex for their sexual gratification. With today’s technology this is just a click away.

This activity of viewing porn on the Internet is widespread and can for many become compulsive and addictive. This can lead to problems. The partner, usually the male, who is using cybersex, is keeping the secret from his partner and is conditioned to now having sex with “perfect” (virtual partners) without having to be emotionally intimate with them. So, we have instant gratification without the perceived “time consuming messiness” of negotiated emotional intimacy. If the partner discovers this activity, the “fallout” for the relationship is the same as if the partner was having an affair with issues of betrayal and a breakdown of trust, as it becomes obvious why the partner was not engaged in the present relationship.

There are what we term definite “sexual dysfunctions” that bring people to sex therapy e.g., Erectile Dysfunction, Disorders of Desire, Anorgasmia, and Premature Ejaculation. In these cases, one partner is holding the dysfunction but the rationale for that can be because of other issues going on in the relationship. These issues may be out of awareness to the couple. This is why accredited sex therapists are trained to assess the relationship and the issues the couples present with, to ascertain where the couple would be best placed to achieve the optimal outcome.

Is it the area of sex therapy or couple counselling?

Once assessments are done informed decisions can be made around this and the work can begin to help the couple or individual to move away from the history of the past and learn a new way to relate to each other in both their sexual emotional intimacy.

College of Sexual and Relationship Therapists (COSRT)

If you believe sex therapy is an option for you it would be important to check that your therapist is an accredited member of COSRT (College of Sexual and Relationship Therapists). This will ensure that your therapist has specific dedicated training in the field, is qualified and is engaged in continuing professional development. .

© Anne Mathews, Psychosexual Therapist and reproduced with her kind permission.