Couples Counseling, Sex Therapy and Sexual Problems

How are Couples Counseling and Sex Therapy related? And how can they work together to help couples address sexual problems?

Sexual Disorders Treated by Sex Therapy

Many sexual difficulties are "located" in one or the other member of the couple. For example, premature ejaculation or erectile difficulties happen within the man's body, while painful intercourse may happen within the woman's body. What is the best way to get help for these kinds of problems?

In most cases, the work of therapy is most efficient and more likely to be successful when both partners are involved. The reason is that, while symptoms of the problem are manifest within one partner's body, the effects are felt by both. The wife of a man who ejaculates too rapidly may feel he does not care for her, or is being selfish, or isn't trying hard enough to be sensitive to her needs. Her emotional response can increase the tension around sex in the relationship, which may have the unintended effect of making the original problem worse.

Similarly, if a woman experiences pain with intercourse: while the symptom is felt by her within her body, her partner may have emotional responses to her pain. He may feel bad or guilty for causing her pain; he may feel she is exaggerating her pain in order to avoid intimacy; he may feel frustrated or sad or disappointed. She cannot help but pick up some of his emotional response -- which, unless it can be talked about and worked through, is likely to increase her feelings of anxiety and tension. This can make the problem of pain with intercourse worse.

The Sex Therapist Pays Attention to Emotional Vulnerability and Deep Feelings in Sex Therapy

The above examples are not meant as exact descriptions of every situation, but point to some of the complexity that can occur. The bottom line is that sexual difficulties affect both partners.

Sex is highly personal. When you are making love you are open and exposed and vulnerable. If something hurtful occurs, like feeling criticized or rejected, it is very easy to take it personally. Sex is also highly emotional -- not only the feelings of desire and arousal, but love and hurt and disappointment and deep yearnings and many other emotions. This natural sensitivity can easily amplify hurt feelings, turning small hurts and disappointments into larger ones over time.

The Sex Therapy Approach that Combines Individual and Couple Counseling

Since both partners are affected (although in different ways) by the sexual problem in the relationship, couples counseling can expedite the healing process and help things to move ahead more quickly. Progress can be made on symptom resolution at the same time emotional responses to the problem are being addressed. Additionally, the partner's presence allows him or her to actively aid in symptom resolution by understanding the process and by participating in carefully structured exercises at home.

However, if your partner is not willing to come with you to sex therapy -- or if you would prefer to begin to work on your issue alone -- you can still make excellent progress. If it is possible to work together on the problem, things can move more quickly.

When both partners want to work together, I prefer to meet you both as a couple for the first meeting. Following that, if you choose to move ahead with sex therapy, I will schedule an individual appointment with each of you in order to learn more about your perspective on the concerns that bring you to therapy. Subsequent meetings will be with both of you as a couple.

My perspective is that each partner in a marriage is an equal co-creator of the "dance" that is your relationship. There are no good guys and bad guys, but rather two people who are trying to navigate the complexities of an adult, intimate relationship.

TheSex Therapy Homework

Talking about sexual problems in the office can be very helpful in resolving emotional reactions, and for re-education to address any mistaken notions about sexuality. (See "Ten Myths About Sexuality" article) But something more is needed for effecting positive changes in behavioral symptoms. Tangible activity is how we learn new skills. As with any kind of skill acquisition, practice is important.

"Intimacy Practices" is the name I use to describe the homework activities I give for between-sessions practice. Intimacy Practices are like other kinds of practice you may be familiar with in your life experience: band practice, football practice, choir practice, play practice. The principle is exactly the same. Successful practice does not depend upon being wildly enthusiastic about the activity being practiced. What is necessary, however, is to "suit up and show up" -- to be willing to do the practice. The result is that you get better at the activity you are practicing.

Sexual behavior is learned behavior in humans -- it's not instinctual behavior as in most other animals. Practice is necessary! With guided practice in carefully calibrated exercises, you can develop greater skill and confidence, thereby overcoming troubling sexual symptoms.

TheSexual Disorders and Relationship Problems Treated with Sex Therapy

I treat a variety of sexual and relationship problems, including:

  • Erectile dysfunction

  • Premature ejaculation

  • Inability to achieve orgams

  • Low desire

  • Compulsive sexual behavior (sex addiction)

  • Painful intercourse

  • Sexual identify issues

  • Anxiety about sex

  • Attracting a partner

  • Communicating more effectively about sex

  • Infidelity

  • Issues with pornography

If you have any questions about my approach to sex therapy and couples counseling, please feel free to contact me at 615.298.4559.