Great things can happen in sex therapy! Maybe you’re having trouble maintaining or getting aroused. Maybe you’re exploring a new queer identity or gender identity. One of the most common types of clients I work with is someone who has experienced a sexual trauma, has done a tonne of trauma processing, but never got support for how to have fun sex.
So… How the hell does sex therapy work, anyway?
Now, before I jump into some different approaches it’s important to remember the top 2 predictors of successful therapy.
The biggest determining factor in successful therapy is actually the client themself.
How do you know if you’re the kind of client that will succeed?
Consider these questions: Do you feel you have enough time and energy to dedicate to your healing process? If you’ve already done some therapy, what worked for you before? What didn’t work? Are you motivated to try new things?
The second biggest determining factor is your relationship with your therapist or counsellor.
Some questions to consider in this realm are: Does your sex therapist/counsellor make you feel safe? Do you like your therapist/counsellor, just like, generally— as a human? Do you feel understood by your sex therapist/counsellor? Do you think/feel your sex therapist/counsellor would be receptive to your feedback about your relationship?
If the answer is no to any of these questions, that’s a big red flag that is worthy of your attention.
Okay, so you’re ready to do the work and dive in! You’ve connected with a therapist! Dreamy! Now what?
Some sex therapy is dedicated to one approach, integrative counsellors like myself like to pull from multiple approaches and apply what seems most appropriate in any given situation.
Here are 5 approaches to sexual health counselling I like to use in my practice:
#1 Narrative Therapy
At the heart of narrative therapy is the idea that we act according to the stories we have been told about ourselves and the world around us. This is a big-picture approach to understanding sex.
I find this approach really useful when cultural norms and peer pressure has made us believe myths about our sexual self, such as, that we must be a particular gender because of our genitals or that we must be heterosexual because most people are (Eh- WRONG!).
Doing the work from a narrative approach involves understanding the story we’ve been telling ourselves or that has been told to us that is keeping us stuck, and finding counter-narratives often just below the surface.
Narrative therapy has often been applauded for being anti-oppressive with strong social justice roots because it positions the client as the storyteller of their own lives, demanding the therapist take a non-authoritative back seat.
It also calls out the destructive narratives of dominant colonial and patriarchal narratives that have been used to control and oppress minority communities, in sexuality, this has been done by making us believe our sexuality is “dirty” or “sinful” if it doesn’t fit the white, able-bodied, heterosexual, Christian (within-marriage, historically) norm.
For all these reasons, narrative therapists are taught to basically get out of the way of the clients healing. The therapist does not write the narrative for the client and is supposed to keep a generally neutral emotional/relational affect (I am definitely more dynamic than a strict narrative therapist).
You probably didn’t hear it here first— Western cultures chronically suffer from a mind-body disconnect. Sexual trauma, in particular, can make the mind-body connection particularly difficult during sex. Mindfulness is a wonderful, non-judgemental, way to reconnect with your body and feelings of arousal.
If this sounds like something you could benefit from and you already have some kind of body-scan mindful practice in your life, try adding an awareness of your erogenous zones— nipples, ears, neck, mouth, clitoris, penis, testicles, labia, vagina… What do you find?
Like reading? Check out this fantastic book by Lori A. Brotto called Better Sex Through Mindfulness
#3 Solutions-focused Therapy
This is my go-to approach for folks who used to enjoy sex, but have found themselves in relationships that have fizzled-out passion for whatever reason.
You know you have a solution-focused therapist when they call your “problem” the “situation” and ask you questions like, “when you experienced this situation in the past, what helped before?” or “if over night your problem was completely solved, it just magically disappeared, what is the first thing you would notice when you woke up?” Many solution-focused techniques have been adopted by coaches.
Solution-focused therapists like to take stock of what tools you already have and see how they can be strengthened and applied to novel situations. What’s great about this approach is that it is non-pathologizing— meaning, we don’t think you’re broken and need fixing, rather, you’ve ended up in a situation that you haven’t found the right tools for yet.
Like reading? Along with a tonne of excellent sex education, Emily Nagoski’s book Come As You Are is filled with solution-focused exercises to help you get back to or start having pleasurable sex!
#4 Cognitive-Behavioural Therapy (CBT)
Admittedly, this is my least favourite theory but it has some of my favourite tools! The theory is very problem-focused, it is pathologizing, and definitely positions the therapist as the expert. I hate all those things.
CBT does bear some resemblance to holistic perspectives in that there is an understanding that behaviour, emotions, and thoughts all interact and influence one another. CBT therapists will often draw a diagram of a cycle you have gotten stuck-in that is feeding your problem. Sometimes this birds-eye view can be pivotal in breaking unhelpful habits. This can be great for sex that has you feeling anxious, or “performance anxiety” that may be underlying arousal or erectile dysfunction.
#5 Compassion-focused Therapy
Shame is often the culprit of much sexual anguish. Whether it is shame from our childhood around masturbation, shame from sexual violence, or shame around our bodies. Every client I have worked with has a relationship with shame. Compassion is the antidote to shame.
Compassion is so much more than peppy memes about how you’re deserving of love and forgiveness— which you are, but it’s deeper than that. Compassion is the ability to tap into our shared humanity, the reality that we are not perfect but that we are enough.
If you have a voice inside your head that is constantly kicking the shit out of you, compassion is the protector. Compassion doesn’t say, “choose happiness, you deserve it!” Compassion says, “Enough. You do not get to treat me this way even if I have made a mistake. I will love and protect me, I will take care of me, because I am an imperfect human like everyone else.” Compassion also keeps us accountable by connecting us with others, by feeding empathy and understanding.
It takes courage to find our compassion. To apologise to ourselves, to forgive ourselves, so we can truly see ourselves with all of our bumps and bruises as well as our beauty and glitter— so we can love ourselves and each other.
These are just a few ways sex therapy can help! Even I have a few more tools up my sleeve, but hopefully this helps you get oriented. Happy pleasure to you!