What Exactly Is Sex Therapy — And Do I Need It?

There are a lot of misconceptions out there about what sex therapists do, says Gisèle Harrison, a counsellor and sex therapist in Windsor, Ont. Before she became one herself, she had a few misconceptions of her own — she’d always pictured Barbra Streisand in Meet the Fockers. “I thought it was kind of like that, a little kooky and weird,” she says. Now, Harrison spends her time educating others about intimacy and giving people the tools they need to have a fulfilling sex life. “There’s a lot of shame involved in issues around sex and a narrow definition of what healthy sexuality is,” she says. “Sex therapy can help a lot of people.”

So, what is it, exactly?

Sex therapists treat both couples and individuals and tackle every sex-related concern you can think of, from erectile dysfunction and painful intercourse to lagging libidos and questions about fetishism or gender identity. “A lot of young people come because they’re not sure who they’re attracted to,” Harrison says. “It’s so important that people have a safe place to go where they can ask these kinds of questions.” One of the most common concerns heterosexual couples see Harrison for is desire discrepancy. “Couples have different libidos and it’s all about navigating the quality and quantity of sex in their relationships,” she says.

In broad terms, Harrison explains sex therapy as taking basic sex education to another level. Harrison says too many people learn everything they thought they needed to know about sex from porn, rom-coms and their high school sex-ed class. There’s a lot more to sex than basic mechanics and learning how to avoid STIs, she says.

How it works

Many therapists follow the PLISSIT (permission, limited information, specific suggestions and intensive therapy) model, which involves four steps: providing a safe space for patients to bring up issues around sex, gathering information, offering a diagnosis and suggestions for how to address the issue and, in some cases, providing more intensive therapies, which may include making referrals to other specialists.

“Sex therapy usually requires a holistic approach,” says Teesha Morgan, a Vancouver-based sex therapist and couples’ counsellor. “I might work with a medical doctor to tackle physical problems like premature ejaculation, or a pelvic floor therapist for someone who experiences pain during intercourse.”

More complex problems may lead to months of therapy, while others can be resolved in a single session. Morgan says it usually depends on the root of the issue, whether it’s biological (like erectile dysfunction caused by medication), behavioural (if lack of sleep is leading to a lagging libido) or psychological (when things like stress or anxiety interfere with intimacy and the relationship in general). If the issue is having a negative impact on the relationship as a whole, it may be helpful for couples to see a therapist together to help them navigate the situation. Often it involves managing expectations around sex and learning to communicate better.

Most therapy sessions involve a Q&A session, as well as some homework. “I ask a lot of questions,” Harrison says. “I want to know who initiates sex, what the cues are, how people communicate, what’s going on in the room and, most importantly, what’s going on in people’s heads.” Harrison says too often sex becomes overly goal focused (as in, it’s not sex unless everyone has an orgasm) and that people’s inner dialogues also tend to get in the way of good sex. (If you’re worrying too much about whether you’re pleasing your partner, or thinking about your overflowing to-do list, it can be hard to relax and enjoy the moment.)

Harrison often assigns some recommended reading and mindful meditation to help people stay focused on pleasure. “Sometimes the homework is just to have fun and play,” she says. “It might simply involve relearning how to touch one another, without focusing on any one part of the body. It’s even better if you do it blindfolded.”

When to go

If you’re considering therapy, it’s best to do a little research first (many couples’ counsellors call themselves sex therapists even though they haven’t had any specific training in how to deal with sex- or gender-related issues). Find out if the therapist has earned a certificate in sex therapy or is registered with the American Association of Sexuality Educators, Counsellors and Therapists. Harrison also recommends interviewing therapists to make sure they’re a good fit and that you feel comfortable talking to them.

Most important, don’t put off getting the help you need. Morgan says people tend to wait too long to see a sex therapist. If sex were easy to talk about, she says, she wouldn’t have a job. “But therapy is much more successful if you get help as soon as you notice a problem or feel worried about something related to your sex life,” she says. The main thing to remember, she adds, is that you’re not alone and pretty much any problem can be fixed.

“Sex therapists are specially trained to provide counselling and a non-judgmental space to deal with any issue around sexuality,” she says. “People come in and often feel anxious at first but, when they’re able to open up, the healing and sense of catharsis they experience as a result is unbelievable.”