Why Seek Therapy in the First Place?
As a psychotherapist, I am trained to help people feel comfortable in uncomfortable situations. Crying, long periods of silence, anger outbursts, lying and denying problems are all part of the therapy session from time to time. It is to be expected and anticipated as a therapist. No one comes to see me when their life is going well… they only come when things are challenging. And, they usually come once they have tried everything their best friend or Dr. Google has suggested. Then, they call me when they are really desperate. And that is okay. I welcome that first call when someone reaches out in despair. It might seem odd, but, from my perspective, I see this as the first step in their healing journey and transformation process, and so, I welcome it.
People call therapists for many reasons. They call when they have lost their job, or lost their passion for their partner, or when they are considering a major life change like divorce or relocation. They call when they get a devasting health diagnosis or when their spouse has suffered a traumatic brain injury or when their beloved pet has died. They call when their teenager gets caught smoking pot and posting nude pictures on social media. They call when they cannot take their toxic work environment any longer or when they are finally ready to talk about being molested as a child. The point is, people come into therapy for so many different reasons and all the reasons are valid and understandable. I only once had a client come simply because their friends were all in therapy and they thought it would be a cool experience. Even then, we did amazing work and transformation occurred.
The Role of Sex and Therapy
With all that being said, you may not know that many people come into psychotherapy because of issues related to sex. Sex is a very broad term in this context. People seek sex therapy for a myriad of reasons. They come for erectile dysfunction, inability to orgasm, fear of sexual intimacy, pain during sex, confusion about sexual preferences, lack of interest in sex or asexuality, shame related to body image or religious upbringing, pornography addiction, performance anxiety, and extra-marital affairs. Clearly, this is not exhaustive list but rather just a smattering of the first 10 things that came into my consciousness as I typed on this keyboard.
The impact of a healthy sex life on your overall wellbeing should not be dismissed or ignored. Lack of sexual intimacy, lack of satisfaction, and lack of connection can reap havoc on marriages and partnerships. On average, married couples report having sex approximately 1x week but 15- 20% of couples report a sexless marriage based (sexless meaning it happens less than 10x per year). Once a week could be feast or famine depending on your level of desire and expectancy. And, we don’t know if it’s satisfying, enjoyable, and fun; we just know that for most couples it happens on a weekly basis.
Healthy Sexual Functioning
Sexual dysfunction can also cause internal chaos. Clients often wonder, “What’s wrong with me?” and they have no one to confide in. Let’s face it, this topic is far too taboo to discuss with the vast majority of your friends. As Americans, we are cautious and embarrassed about the topic of sex. We just repress our fears, desires, and questions and focus on the easy stuff like helping our kids make the travel soccer team or baking the best cake for school cake-walk. Sex can wait and wait it does.
We often feel alone in our desires for sexual exploration. We assume that our best friends are having scrumptious, exciting sexual escapades with their husbands around the clock or that they have never considered the dark pleasures of ropes and chains like we have. We automatically assume that our co-workers and cross-fit friends know how to control their masturbation and pornographic use better than we do. And, there’s no way that our friends are dealing with repercussions of premature ejaculation and performance anxiety like we experience. The truth is, we make up all sorts of stories in our heads because we are afraid to ask the questions and explore this secretive topic.
In writing this blog I wanted to address the topic sex as it pertains to psychotherapy so that it can be demystified. Talking about sex with your therapist should be as normal as reporting your depression symptoms or the ugly details of the fight you and your spouse had last night. Sex is a basic human function and a need, and therefore, there is nothing strange or taboo about it. And, as a therapist, it is my job to make your feel comfortable in this discussion. I am very cognizant that if I do not broach the subject directly, many clients will be too shy to mention it themselves, even if it is on their mind.
How do I make you comfortable, you may wonder? Well, firstly, I bring it up in the very first session. Yes, the first session. Just as I am asking you about your life history and anxiety symptoms, I am going to ask you about your sex life. I am going to ask you if it is satisfying and I am going to ask if your sexual libido has changed recently. I want to know how your sex life is impacting your partnership, your mood, and your overall health functioning. Secondly, I am going to normalize your experience. I am going to tell you that it is okay to be nervous or awkward and that it is highly unlikely that whatever you report will be any more unusual than what has been reported by others or what I have studied. Thirdly, I am going to follow your lead. If you tell me that everything is great and that there are no complaints then we’ll move on to the next topic until such time that we may need to revisit the subject as it relates to your clinical issues. If, on the other hand, you need to spend 30 minutes talking about how painful sex has become since entering menopause and how this change is impacting your connection with your new lover, then we will spend as long as you need talking about this issue. Lastly, I am always going to leave the door to open to revisiting this discussion in subsequent sessions.
Sex is Normal
In my clinical experience, when sex is approached in this neutral and non-threatening manner, my clients always respond with ease. Often, they are relieved that I brought it up and they are thankful to make the connection about how their lack-luster libido has impacted the health of their marriage. They pick up on the vibe that it is okay to talk about and that sexual health is an important aspect of their overall wellbeing. They also take comfort in knowing that whatever issue exists, it can be treated. For some clients, sex itself is not terribly important to their clinical issue and we move on. But for many others, it becomes a topic that relates directly to their depression, low self-esteem, or marital discord. Again, it is my job to help you see those connections and to help you make modifications that bring about greater happiness and ease in your life.
As a psychotherapist, talking about sex truly is normal (and expected) within the safety and privacy of the clinical session. However, the topics of human sexuality and abnormal sexual behavior are not my area of expertise. Simply put, I am not expert on the topic of sex. Think of me as a generalist much like your primary care physician. I know a lot of things about a lot of things, but if you have a specific clinical sexual concern, you may need an expert. For most clients, expert attention is not required, but, when an expert clinician is needed, it is important for you to know that such professionals do exist. Depending on your needs, you may benefit from working with a Certified Sex Therapist, a Surrogate Partner, a Human Connection Coach, or a medical doctor who specializes in sexual health.
Questions? Just Ask.
My hope is that after reading this article, you have a more informed position on how sexual health is an important component of overall health functioning. It is also my hope that you have learned something about your sexual tendencies, fears, or desires.
Perhaps something written here has sparked your interest or helped you clarify some feelings you have been repressing or ignoring. If you are currently working with a psychotherapist, psychologist, or medical doctor, I hope that you have the courage to speak to your provider about your sexual needs and concerns, even if they have not paved the way for this conversation.
If you would like to learn more about working with me, please feel free to call me on 443.951.3986. I am licensed to provide psychotherapy (i.e. counseling) in the state of Maryland. If you reside outside of Maryland, I can help you find a local resource.