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Sex is the gateway to life.
- Frank Harris
Appreciating the larger context of "sexual dysfunction" There has been a trend in recent years to create
the illusion that difficulty in sexual functioning is best managed by medical intervention. While there is, clearly, a place
for medicine in the realm of sexual issues, it is not the only option. Concerned about the increasing medicalization of human
sexual experience Kaschek and Tiefer, (2001), developed a feminist, biopsychosocial perspective, which they refer to as “The
New View of Women’s Sexual Problems”. The New View perspective challenges the concept that sexual problems are
medical problems, and maintains that sexual problems are driven by multiple realities. These realities include;- Sexual problems due to socio-cultural, political,
or economic factors
- Sexual
problems relating to partner or relationship factors
- Sexual problems due to psychological factors
- Sexual problems due to medical factors
I have found
Kaschek and Tiefer’s model to be helpful to gay, straight, bisexual, and transgendered, men and women. I have also found
that this model invites people to view their sexual experiences, expression and eroticism, as their own. This realization
often empowers one to self define what is "normative" sexual experience by ones own definition.
What is sex therapy?
Our sexuality, as well as our understanding of the erotic, is interwoven within the
physical, emotional, psychological and spiritual dimensions of being human. Sex therapy is about working with individuals
and couples to learn new ways to explore, express and integrate the joy of sexuality in all it's complexity. This may mean
offering education about how to better communicate ones sexual desire to a partner, for others it may mean focusing on sexual
difficulties such as erectile problems, low sexual desire and difficulties with orgasm or pain that occurs during sexual activity.
A sex therapist may also work with a couple, or individual, to determine how they wish to define and pursue their own definition
of optimal sexual functioning and the struggles that prevent them from attaining this goal.
People who are
interested in seeking help to improve their sexual relationships are frequently left scratching their heads trying to understand
what sex therapy is and what a sex therapist does. This lack of understanding is often compounded by our cultures uneasy,
often hostile, relationship to sex, sexuality and sexual pleasure. The tragedy with this perspective is that it prevents people
from understanding that sex and sexuality are complex, multidimensional aspects of the human experience and a powerful source
of life affirming connection.
Both straight and gay couples benefit from sex therapy, often reporting that
not only has there been an improvement in the quality of their sexual intimacy but a deepening trust and emotional connection
with their partner. Individuals can also benefit from sex therapy by discussing concerns about their thoughts, feelings and
experiences related to sex and sexuality and the desire to explore other aspects of their sexual selves.
When a couple, or individual, enters sex therapy they can expect a combination of interventions that include, a) assessment
of the presenting issues, b) assessment of the couple, or individuals, style of relationship, c) sexuality education, and
d) directed therapeutic interventions.
a) Assessment of the presenting issues begins with the our exploring:
• Current and past sexual functioning
• Understanding sexual attitudes and experiences
• The ways
in past experiences may contribute to issues in the here and now
• Discussing what one has learned about the role
of sex and intimacy
• Assessing if body image is impacting on ones expression of sexuality
• Exploration
of health issues that may interfere with current sexual functioning
b) Assessment of the couples, or individuals,
interpersonal relationship styles begins with:
• Exploring emotional issues that may impact sexual expression
• Exploring the sexual styles that each individual brings to their relationship
• Understanding the role
of trust in emotional and sexual relationships
c) Sexuality education:
• Discussing the anatomy
and physiology of sex and sexuality
• Discussing and combining sexuality, trust and play into sexual expression
• Suggesting reading materials
d) Directed therapeutic intervention:
• Structured homework
assignments
• Challenging unhelpful patterns of communication
• Developing tools to enhance sexual expression
and intimacy
• Referrals for medical evaluations or other interventions as needed
Common questions related to sex therapy.
Q. Does a sex therapist have sex
with their clients?
A. Absolutely NOT! This is illegal and unethical. A sex therapist will not touch you,
or expect you to be sexual with him or her, in any way, shape or form. A sex therapist is a trained and licensed mental health
professional such as a social worker, psychologist, marriage and family therapist or licensed counselor. While sex therapy
often includes the explicit discussion of sexual material, and the interventions offered are sometimes sexual in nature, to
be explored in the privacy of ones home with ones self or ones partner, there will never be any form of sexual interaction
with the therapist.
Q. What are the requirements to become a sex therapist?
A. After
completing a graduate degree, this may be in social work, clinical psychology, marriage and family therapy or mental health
counseling and a period of post graduate training and supervision; one becomes licensed in their specific discipline. The
sex therapist then acquires additional specialized training, and supervision in the field of sexology and sex therapy. The
most basic requirements to become certified as a sex therapist require an additional 120 hours of training in the areas of
sexual diversity, sexual anatomy and physiology, gender issues and relational dynamics, research methodologies in the field
of sexuality and sex therapy, the effects of substance use and abuse on sexual functioning, the role of sexual abuse on attitudes
and experiences of sex and sexuality, sexuality and pathology as well as the assessment, diagnosis and treatment of sexual
dysfunction.
Q. How long does sex therapy last?
A. Sex therapy, historically, has been considered
a shorter-term therapy that has focused specifically on sexual issues. However, like any form of therapy it is difficult to
determine how long therapy will last. This can be determined between you and your therapist.
Q. Do sex therapists
only work with sexuality issues?
A. That depends. Many sex therapists work with a variety of issues. As sex
therapists are trained psychotherapists, the scope of their practice frequently includes a broad range of clients. Most sex
therapists have extensive experience treating concerns such as substance abuse, depression, anxiety, sexual abuse and general
life transition challenges. Other sex therapists choose to focus specifically on issues of sex and sexuality.
Q. If I have a medical concern that is impacting my sexual functioning, can you help me locate a provider that will address
this issue with me?
A. Absolutely! Sometimes problems related to sexual functioning require medical intervention.
For men, this may mean working with an urologist to explore issues related to genital blood flow, testosterone levels, prostate
issues or other concerns with genital functioning. For women, this may include meeting with a gynecologist or other medical
personal, to explore sexual pain issues or problems with lubrication. Whatever the issue, a medical consultation, or consultation
with other sexuality professionals can be arranged and included in your therapy.
Recommended readings:
Paul Joannides and Dearick Gross Sr. (2009). The Guide to Getting it On. Goofy Foot
Press.
Felice Newman. (2004). The Whole Lesbian Sex Book: A Passionate Guide for All of Us. California. Cleis
Press, Inc.
Barry W. MCCarthy & Michael E. Metz. (2008). Men’s Sexual Health: Fitness For Satisfying
Sex. New York. Routledge.
Tammy Nelson. (2008). Getting The Sex You Want: Shed Your Inhibitions and Reach
New Heights of Passion Together. Massachusetts. Quiver.
Gina Ogden. (1999). Women who Love Sex: Ordinary
Women Discuss Their Paths to Pleasure, Intimacy and Ecstasy. Boston, Trumpeter Press.
Gina Ogden. (2008).
The Return of Desire: A Guide to Rediscovering Your Sexual Passion. Boston. Trumpeter Press.
Charles Silverstein
& Felice Picano. (2003). The Joy of Gay Sex 3rd Edition: Revised and Expanded. New York. Harper Collins.
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