Specialist Q&A: What Can a Sex Therapist Do for You?

Sadat: As a sex therapist, I'm looking to help people improve aspects of their sexuality and their sex lives. It ranges from challenges they may be having with sex, such as pain, to an absence of interest in having sex.

Sex therapy can also look like working with the relationship and helping my clients navigate

challenges they may be facing as a unit, like changes in the relationship because they've had children or if they are dealing with cancer treatment or recovery.

I've been in practice officially as a sex therapist for more than four years. But I've been in the sexual health and wellness industry for about eight years. I've been training to be a sex therapist for longer than that. I completed my master's in counseling psychology at Adler University, Vancouver, British Columbia. I also did a sex therapy certificate program in the United States and I became a certified sex therapist through the American Association of Sexuality Educators, Counselors and Therapists just two years ago. I'm currently also a sex therapy supervisor in training.

Sex therapy in and of itself isn't a regulated term, and in British Columbia, counseling isn't even a regulated profession. So the reality is that anyone could call themselves a sex therapist if they wanted to.

I followed the path of AASECT because it's an international organization that holds its members to a high expectation of what you need to become a sex therapist. According to them, you need a master's degree. Then there are about 150 hours of education in sexuality, as well as 60 additional hours of sex therapy education, 300 clinical hours of practice and a ton of supervision.

For someone to call themselves a sex therapist, they need to have a broad range of knowledge on a variety of different sexual issues. There are a lot of therapists who know a lot of things about certain areas of sexuality. For instance, they might know a lot about desire.

However, I recommend finding a sex therapist who does have foundational knowledge in all the different areas of sex and sexuality. While they may not know every area as a specialty, they have sufficient knowledge in the different areas. This might include anatomy, contraception and sexual health as a whole.

It's also important to understand aspects of people's sexual history and their knowledge of how to take a sexual history. There are a lot of different aspects to sexuality we sometimes forget. Sex therapists are trained to be able to assess all the different areas and not just zero in on one.

A lot of people don't need more than education; education is a big part of what we do.

As a client looking for a sex therapist, you want to ask questions about what type of education they have and where they went to school. Details such as how long they've been practicing and [whether] they have [or had] supervision from other experienced sex therapists are all important because a lot of people just have self-knowledge as experience.

The most common reason people see a sex therapist is a loss of interest in sex. Maybe they once had more interest, or maybe they were having more frequent sex at the start of a relationship and that's changed. That tends to be the most common reason across genders.

We also see men and people with penises with issues such as erectile dysfunction, and rapid and delayed ejaculation. For women and people with vaginas, difficulties with orgasm and sexual pain tend to be other common reasons.

Sometimes people who are considering opening up their relationship and being in an ethically nonmonogamous relationship may want to seek a sex therapist to help them navigate the feelings and challenges that come with it. People also come to sex therapy for anything related to exploring different aspects of sex and sexual behavior, such as kinks or fetishes.

I like to say, "If it's around sex or it's about sex, a sex therapist can probably work with it."

Firstly, no touching happens in a session. It's talk therapy, so it's about talking and exploring and sometimes coming up with problem-solving ideas and solutions for the presenting concern.

Sometimes people are a little bit worried because they're not sure what it entails, so we like to be clear about that.

Another thing to know is that sex therapy doesn't always involve specifically talking about sex itself. It could be that sex issues emerge from other areas of their life, such as depression or anxiety, and it's showing up specifically in sex. It's not uncommon for clients to come in about a sexual concern and then we end up having to do work around anxiety, depression, trauma or childhood issues that have happened. They're contributing to the issue that's bringing them in in the first place.

The final thing clients should know is that there are often going to be activities or exercises that they're going to have to practice between sessions that are going to help them. People should be prepared to make time not just for weekly or biweekly sessions but to also engage in different activities on their own, before coming back to session and talking about it as part of the process.

Come prepared to answer all types of questions. The more you can give us or the more information you feel comfortable sharing, the more helpful it will be, because in the first few sessions, we're trying to understand what's going on.

If possible, go to a doctor beforehand to get a medical workup done, because we always like to rule out any sort of medical or biological reasons for the issue. That's not to say it's necessary by any means because it's something we can always talk about in session as well. That being said, it can help make sure we have some information about any medical components that might be contributing to the concern.

In British Columbia, we don't officially make any sort of diagnosis. We let psychologists and doctors make diagnoses. If clients want a diagnosis, we refer them back to their doctor.

Our focus is primarily just on what's concerning you and how we can address it. How can we eliminate or reduce those symptoms?

First sessions are not always as deep as follow-up sessions.

During the first session, we're trying to assess all the different areas of people's lives. So we try to figure out what's going on and decide how we're going to move forward from here. You can expect a lot of questions to come up. We cover forms on ethics and what they can expect from us as counselors in general. But we're talking a lot about assessment. Together, we're trying to understand what's going on and why it is happening.

Then we're going to come up with a treatment plan. "How are we going to work on this in terms of how many sessions you should expect?" That's probably one of the most common questions we get, and probably the hardest question to answer, because there's no real way to know how many sessions it might take.

What I usually like to say is you'll start to see and feel changes within five sessions. In terms of how long it may take to work on the issue, it depends on so many factors, such as how long it's been going on and the root cause of it; it depends on what the goal is. It might take anywhere from a couple of sessions up to 10 or more sessions.

As a sex therapist, I'd say I work most often with pelvic floor physiotherapists. They're registered physiotherapists who specialize in the pelvic floor. So we send clients to them often if they're having sexual pain and even if they're having difficulties with erectile functioning. They're also the people who refer to us the most because there's such a psychological component to pain as well.

Other than that, family doctors tend to send some clients our way, oftentimes when they've tried medications and they're not working and there's probably a suspected psychological reason for what's going on.

Sometimes [we work with] specialists like neurologists and gynecologists if they think there is a psychological component to the issue. There's almost always a psychological component to any sort of sexual issue. Even if it's medical in nature, they're more likely to send them to a sex therapist to help them through the treatment.

I recommend people have phone consultations before booking an appointment.

Some questions are more general than just therapy, like: How often should I be coming to sessions? Or do you have experience working with people who are struggling with the same thing as me? What kind of training do you have? How do you continue receiving education on this topic? Who else do you know or work with? Are there people you might want to refer me to if I need additional support? Who might those people be?

Ask them how they practice or show up in the session. How do they show up in session? "What can I expect to feel when I'm in session with you?" is an important question because just getting a feel of their personality is important to the success of your work. With sex therapy, we treat it like it's medical or as if we're coming in for a doctor's appointment. But sex therapy is, ultimately, therapy.

The relationship you have with your counselor is one of the most important elements of successful treatment. So in a scenario where two people possess the same knowledge but you get along more with one, you're much more likely to succeed in therapy with the person you like because that relationship is what contributes to the healing as well.

Ensure you ask how they are in session. Getting a feel of their personality is important to the success of your work.

The best advice I can give any client is to be as honest as they can be through our work together, whether that's with the information they give me or if something isn't working for them. If they don't feel like it's working, the more they can share with me, the more I can do something about it.

I like to say not everything I know is going to work for someone. What's good for 80 percent of people might not be for the other 20 percent. And we're only going to know how to adapt what we need to do for that person through direct feedback. [I advise] honesty and commitment to coming to sessions regularly and doing the work between sessions.

If there was a magic breakthrough, I would love to see a cultural shift in how we talk about sex and how we view sex. I think that would be more powerful than any medication or technique that therapists could create.