Stigma against talk of mental health has declined as of late, but it still persists — especially when it comes to forms like sex therapy. The internet has lots of sex advice but, in some cases, you may want or need help from a professional. Mashable spoke to two sex therapists about what the practice actually is, who's a good candidate (spoiler: everyone), and why you may benefit from it.
What is sex therapy?
While a bit self-explanatory, sex therapy is counseling specifically focused on sex. This is a wide net, as sex is in itself an umbrella topic.
Sex and marriage and family therapist and host of the Sluts and Scholars podcast, Nicoletta Heidegger, listed some reasons why clients go see her: physical pain like pelvic pain; desire discrepancies (frequency or kind of sex); people who want to open their relationship or are currently open; people who want to explore kink and BDSM; sexual trauma; people who may want to transition; people who have never orgasmed or struggle to experience the type of pleasure they want, either solo or partnered; people who have unwanted (unethical or illegal) desires and fantasies; and those with sexual shame.
The overarching theme for all of this is shame, Heidegger said. Sexual shame is ingrained in our culture — evidenced by the lack of comprehensive sex education in schools and prudish social media rules that force us to call it "s3x" — and it may help to have a professional by your side to unravel it all.
"We go at the client's pace," said Heidegger. "We don't automatically jump in and go into stuff that's too scary." Heidegger, for example, provides talk therapy and often gives clients educational materials and referrals (for example, a pelvic pain specialist if a client is experiencing such pain). Work outside of session may look like reading books, journaling, medication, and hands-on pleasure exploration called pleasure mapping.
Does a sex therapist touch you?
"Sex therapy does not include touch," Heidegger clarified. There are practitioners who do touch (like massage therapists), and sex therapists may refer clients to these hands-on treatments, but they don't perform them themselves.
Who should go to sex therapy?
Basically anyone can benefit from sex therapy, both experts said. "Anybody who has shame about their body during sex or shame about what they want during sex is an appropriate candidate for sex therapy," said psychotherapist and president of boutique therapy service Unicorn Health Care, Emma Jackson Smith. "People who are having difficulty experiencing orgasm, maintaining an erection, getting aroused…those are questions worth exploring." This is especially true if you've already been to a doctor for these issues and they don't find anything wrong; the next step could be sex therapy.
In Heidegger's experience, clients typically wait to start therapy until things aren't going well — but it doesn't have to be that way.
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"I think everybody should go [to sex therapy] preventatively to figure out…what they like, what they're into and how to connect with themselves and other people," she said.
It's not necessary to have gone through general therapy before starting sex therapy, but Smith said it may be helpful. If you can't name your emotions or aren't used to being introspective, general therapy can be a good start.
Further, know that a sexual problem likely isn't just about sex.
"Even when it's about sex, it's never just about sex," Heidegger said. "Anything sex related is usually going to be…bio-psycho-social," meaning intertwined between someone's physical body (biology and physiology), mind (psychology), and cultural upbringing (social).
"Struggling with something sexually usually involves the intersection of all how these all connect with one another," Heidegger continued. "Sexuality impacts many facets of our life and on the flip side, many facets of our life can impact the complex web that affects our desire and arousal."
What do I look for in a sex therapist?
Do your research and ask potential therapists questions about their credentials. What qualifies someone to call themselves a "sex therapist" will vary based on your state or country. In California, where Heidegger is based, for example, one can't call themselves a sex therapist without a therapy license.
Also, unlike other forms of therapy like marriage and family therapy, there's no licensing board for sex therapy (at least in the U.S.), so there are certification groups like the American Association of Sexuality Educators, Counselors, and Therapists (AASECT).
Make sure to ask a potential therapist what their training is in human sexuality, said Heidegger. Smith concurred, saying a sex therapist should be able to explain how they work with clients, what classes they've taken, and how they got into this work.
If you're marginalized in any way, ask what their experience is in working with people like you (or look at their website if you don't feel comfortable asking verbally). If you're non-monogamous, for example, you'll want to find a therapist who affirms the non-monogamous lifestyle.
A red flag is if a therapist can't or won't explain their credentials. In Smith's opinion, another red flag is a therapist who "yucks someone else's yum" — like if they refuse to work with kinky or polyamorous clients.
If you have more direct questions about sex and don't necessarily want to dive as deep, you can opt for a sex coach.
How do I pay for sex therapy?
If you're in the U.S. and have insurance, "go through the pain of contacting your insurance company and figure out what is actually in your plan," Smith recommends. Ask about out-of-network benefits, out-of-pocket max, and your deductible.
"Not even just for sex therapy, but just because billing departments screw things up," she said, "and if you don't know what is in your plan then you don't even know if [they've] made a mistake."
Look at practices that take insurance. Maybe you start seeing someone for anxiety about sex, and while your plan doesn't cover sex therapy, it covers treatment for anxiety. "It might be a gateway…to using insurance benefits," said Smith.
You can also look for therapists who have sliding scale fees, which are adjusted based on someone's income and life circumstances.
A way to get cheaper therapy is to go to someone who just graduated and is interning under a more experienced therapist's supervision; associates will be cheaper to go to than their supervisor as they're still in training.
Don't write off these new therapists, said Smith. Somebody with 30 years of experience may be brilliant, but a newer therapist may be more sex- and identity-affirming and trauma-informed. They also may be more versed in current research as they just had to write about it in school, she said.
Non-profits like rape crisis centers may offer free or low-cost services as well.
What are other sex resources?
Even with these options, therapy may be inaccessible to you. Thanks to the internet, though, there are other free or low-cost resources.
One way to learn more about sex and sexuality is through podcasts like Sluts and Scholars, which is part of a podcast network called Pleasure Podcasts, which has other shows hosted by sex educators and experts as well.
There's also NSFW (but not porn) educational sites like Beducated that have courses dedicated to various sexual topics. Another option are books, such as Come as You Are by Emily Nagoski.
Why go to sex therapy?
Sex therapy may feel like a luxury item because we've been told pleasure is superfluous, said Smith, and she wants to challenge this thinking.
"You feeling good and experiencing pleasure through your body — which is how we interact with the physical world, is through our body — it's important," she said.
"When somebody can feel better being in their body during something as intimate and maybe vulnerable as sex, I have seen people have ripple effects across their entire life," she continued. "The way you move through the world is different when you are able to have good sex."
Furthermore, it's okay to need to learn how to have better sex, Heidegger said. It doesn't mean something's wrong with you — no one taught us how to do this. Having great, connected sex over time takes work, effort, time, and energy.
"You deserve pleasure," Heidegger said. "Pleasure is a human right and it's essential to our survival."
Topics Mental Health Sex
