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Joseph Winn MSW, LICSW, CST-S

Sex Therapy

“In America sex is an obsession, in other parts of the world it is a fact.” 

- Marlene Dietrich

What is sex therapy?

People interested in improving their relationship to sexuality are often left scratching their heads trying to understand what sex therapy is and what a sex therapist does. This lack of understanding is compounded by our cultures uneasy relationship with sexuality and pleasure. One of the many unfortunate results of this discomfort is the overlooked recognition that sexuality is a pathway to greater self-understanding and empathy for others (Aanstoos, 2012).

What is a sex therapist?

Sex therapists are trained psychotherapists. This means that most sex therapists also treat individuals, families, and couples dealing confronting issues such as depression, anxiety, past traumatic events, substance abuse issues, and general life transitions. Sex therapists, in addition to their formal graduate education, are trained mental health professionals that work to remove the blocks that inhibit people from fully integrating sex, sexuality and eroticism into their lives and relationships. These blocks may stem from past traumatic events, health issues, relational problems, psychological or social struggles, or some combination of these issues (Tiefer, 2012). In short, sex therapists are trained to listen to the sexual stories of their clients (Risen, 2010) and assist in creating tools and strategies to understand and resolve these problems.

What should I ask a potential sex therapist?

There are no licensing bodies that regulate the tittle of sex therapist or the practice of sex therapy. While there are many well-meaning psychotherapists that list sex therapy as an area of treatment, they often have little to no formal education or supervision in how to assess work toward the resolution of difficulties in sexual functioning. It’s not uncommon to hear clinician report that ‘if the relationship gets better the sex will follow’. Unfortunately, this is frequently not the case. There are several indicators that a clinician has had specialized education, training, and supervision in understanding and treating sexual concerns. The first is certification as a sex therapist through The American Association of Sexuality Educators, Counselors and Therapists (AASECT). Secondly, membership in The Society for Sex Therapy and Research (SSTAR), is also an indicator that a therapist has demonstrated, through a peer reviewed admission process, that they have significant practice and training in the practice of sex therapy.

Some clinicians practicing sex therapy have had excellent education, training and supervision in sex therapy but have chosen not to pursue certification. If a clinician cannot describe different approaches to the treatment of sexual difficulty, provide a succinct description between healthy and problematic sexual behavior, you may want to continue searching for a sex therapist. 

What Can I Expect to Happen in Sex Therapy?

When people enter sex therapy they can expect the following, a welcoming and respectful environment in which the therapist begins; a) assessment of the presenting issues, b) developing an understanding of the couples, or individuals, style of relationship, c) information and sexuality education as needed, and d) directed therapeutic interventions.

Common questions related to sex therapy.

Q. Does a sex therapist have sex with their clients?

A. NO! This is illegal and unethical. A sex therapist will not touch you or expect you to be sexual with them in any way. Sex therapists are licensed mental health professionals and are legally and ethically bound by law from engaging in sexual behavior with their clients. If a licensed mental health professional is asking you to be sexual with them in any way they are violating the therapeutic relationship, your trust, and breaking the law.

Sex therapy includes frank discussions about sexual concerns. The interventions offered to address and improve these concerns may, at times, include homework assignments and practices that are sexual in nature. These interventions are to be explored and practiced in the privacy of your home with yourself and or your partner or partners.

Q. What are the requirements for becoming a certified sex therapist?

After completing graduate school the clinician is required to complete a period of post graduate training and supervision leading to independent licensure. After becoming independently licensed, the therapist then begins the process of working towards specialized training, supervision, and practice as a sexuality professional.

The requirements to become a certified sex therapist are demanding. AASECT certified sex therapists are required to complete the 90 hours of basic human sexuality education in sexual anatomy and physiology, human sexuality through-out the lifespan, variance in human sexuality, consent and coercion in sexual dynamics, gender identity issues, relational dynamics, substance use in sexual functioning, forensic issues, and research methods common in sexology.

Certified sex therapists are also required to complete 60 hours of training in sex therapy specific techniques in treating sexual dysfunction. In addition, sex therapists must also complete a Sexual Attitude Reassessment, or SAR. The SAR is an educational experience in which participants are required to identity their attitudes, feelings, values and reactions to various forms of sexuality and erotic expression. The intent of this experience is to explore their how their biases may impact their clinical work as sex therapists.

Certified sex therapists are required to complete a minimum of 50 hours of clinical supervision with a certified supervisor and provide a minimum of 300 hours of sex therapy providing treatment to individuals and couples presenting with arousal, desire, orgasm, and sexual pain issues.

Most sex therapist also have specific training and supervision in various forms of couples’ therapy. After completing these requirements, the therapist is required to write a position statement clarifying their philosophy and perspectives on sex therapy and submit their application for certification to AASECT. The AASECT Certifying Committee reviews the applicant’s education, training, and position statement and if the supervisor, and the candidate’s recommendations are supportive, the candidate is granted certification as a sex therapist.

Q. How long does sex therapy last?

A. Determining the length of sex therapy, as with any form of psychotherapy, is difficult. Some issues may be resolved relatively quickly, while others may take longer to resolve.

Q. Do sex therapists only work with sexuality issues?

A. Generally, no. Sex therapists, as stated earlier, are mental health professionals and often treat a broad range of clients and issues. Most sex therapists have extensive experience treating clients struggling substance abuse, depression, anxiety, sexual abuse and assault, domestic violence, and various other psychological and social concerns.

Q. If I have a medical concern that is impacting my sexuality, can a sex therapist help me locate a provider to address these issues?

A. Absolutely! Sometimes problems related to sexual functioning require medical attention. Medical concerns that can impact sexuality include diabetes, hyperthyroidism, MS, COPD, CHF, to name only a few. A medical consultation should be arranged to rule out the presence of physiological issues that could undermine your sexual functioning.

Recommended readings: 

Anastomose, C. M. (2012). A Phenomenology of Sexual Experiencing. In, Kleinplatz, P. (Ed.). New Directions in Sex Therapy: Innovations and Alternatives. (2nd Edition). (pp. 51-67). New York, NY: Routledge.

Joannides, P., & Gross, D. (2009). The Guide to Getting It On. Oregon, USA. Goofy Foot Press.

Kleinplatz, P. J. (2012). Is That All There Is? A New Critique of the Goals of Sex Therapy. In,

Kleinplatz, P. (Ed.). New Directions in Sex Therapy: Innovations and Alternatives. (2nd Edition). (pp. 101-118). New York, NY: Routledge.

Newman, F. (2004). The Whole Lesbian Sex Book: A Passionate Guide for All of Us. San Francisco, CA: Clies Press, Inc.

McCarthy, B. W., & Metz, M. E. (2008). Men’s Sexual Health: Fitness for Satisfying Sex. New York, NY: Routledge.

Risen, C. B. (2010). Listening to Sexual Stories. In, Levine, S. B., Risen, C. B. & Althof, S. E. (Eds.). Handbook of Clinical Sexuality for Mental Health Professionals. (pp. 1-20). New York, NY: Routledge.

Silverstein, C. & Picano, F. (2003). The Joy of Gay Sex: Revised and Expanded. (3rd Edition). New York. Harper Collins.

Tiefer, L. (2012). The “New View” Campaign: A Feminist Critique of Sex Therapy and an Alternative Vision. In, Kleinplatz, P. (Ed.).  New Directions in Sex Therapy: Innovations and Alternatives. (2nd Edition). (pp. 21-35). New York, NY: Routledge.