Sex therapist is not a protected title. This means that anyone can hang a shingle out proclaiming to be a sex therapist without having any particular training. In order to avoid a bad experience with sex therapy the consumer should be educated about what sex therapy is, and why only licensed psychotherapists should practice it.
Sex therapy came into being in the 1960’s, with the publication of Masters and Johnson’s groundbreaking book The Human Sexual Response. In this book the physiological aspects of sex were detailed and described. The human sexual response cycle was born describing the following sequence of sexual excitement: arousal building, peaking to orgasm and then subsiding (arousal, orgasm, resolution). Some years later, desire was added to the cycle indicating that people needed to first feel like having sex. From these phases of the cycle came the description of the sexual dysfunctions – ways that sex could fail: for men failure to be aroused was characterized by erectile dysfunction, while orgasm problems were classified as either premature ejaculation (coming too quickly) or delayed ejaculation. For women the situation was a bit more complex, with arousal problems not having a clear physiological marker, and orgasm problems being defined as the inability to have orgasms either with a partner or on one’s own. Lack of desire was defined similarly for both men and women, while women had an added sexual problem – pain from intercourse. Psychological issues, particularly anxiety, were thought to cause these dysfunctions.
In the 1980’s when I began practicing sex therapy, it was pretty straightforward. People had well-defined sexual problems (described above) for which there were well-defined treatments. Today, the situation is more complicated. Yes, men and women still come to therapy for sexual dysfunctions. And while psychological and relationship issues are invariably involved, physical health and medication side effects are often implicated as well. But many people now come to sex therapy for problems related to their experience of sex, sexual intimacy and sexual pleasure.
Why don’t I want sex? I’m worried that my sexual interests are so unusual that any future partner will reject me. I just can’t seem to get over the sexual abuse I suffered as a child. I always lose interest in sex in long-term relationships – is this an intimacy issue? It’s easier for me to watch Internet porn than to initiate sex with my partner. I had an affair, I’m tempted to have an affair, we are trying to resume being sexual after an affair.
Sex is complicated and never more so than when there are problems. Choosing a qualified therapist is the most important treatment decision you will make.