What Happens in Sex Therapy? A Realistic Guide to What to Expect

 The Basics 

Sex therapists are therapists that have advanced training in sexual health.  They provide treatment for a range of things like:

• Sexual dysfunction: any problem that is interfering with you having sex that is consenting and pleasurable



• Communication: how to have tough conversations about sex and intimacy

• Understanding the impact of your mental health condition on your sex life, and how sex you enjoy can be a part of mental health treatment 

Who is a sex therapist? 

“Sex therapist” isn’t a protected term in the state of Massachusetts.  This means someone can technically call themselves a “sex therapist” if they have an interest or aptitude in talking about sexual wellbeing. 

But usually, a sex therapist refers to a type of therapist.  This could be a clinical social worker, psychologist, mental health counselor or marriage and family therapist.  Each of these professions have masters degrees or doctorates in their field, and they have a license to practice therapy.  This means they’ve completed a certain amount of education, and had their work supervised by someone more senior in the field for a certain number of years.  In order to keep their license, they have to complete professional development to stay up to date on developments in their field. 

If a therapist chooses to pursue advanced education in sex therapy, they’re doing this after they’ve already licensed to practice independently.

Many sex therapists will talk about being “AASECT certified” and what this means is they have completed a specific set of requirements outlined by the American Association of Sexuality Educators, Counselors, and Therapists. 

To be AASECT certified, you must complete advanced education in human sexuality, even more hours of supervised practice, and supervision in both individual and group settings with colleagues with more seniority in the field. 

The requirements take around two years to complete, and are so intensive that many programs offer a PhD in clinical sexology that fulfills the AASECT requirements. 

If someone is an AASECT certified sex therapist, they will have the initials “CST” for “certified sex therapist” after their name, listed with their other licenses or degrees. 

What isn’t sex therapy? 

Sex therapy is not sex work.  A sex therapist will not have sex with you, or touch you at all.  They will not role play or stimulate sex acts.  They might show you how certain devices work, but they will not demonstrate on themselves or you. 

If a sex therapist asks detailed questions about your sex life, it is for treatment, not their sexual gratification or yours. 

Sex therapists will end treatment with you if you send them explicit content or masturbate during sessions. If the therapist is soliciting any of this material from you it is a red flag, and it means they have stepped WAY outside of their professional code of ethics. 

Does insurance cover sex therapy?

Insurance will generally cover sex therapy, but there are some big “Ifs” to consider. 

Is the therapist in-network with your insurance plan? Most sex therapists have left insurance panels as the reimbursement rates offered have neither kept pace with inflation nor the cost of pursuing advanced education in sex therapy. 

Does your insurance plan offer out-of-network benefits? Some insurance will reimburse you for costs that you have spent on your healthcare.  Sometimes they reimburse you a percentage of the cost, or up to a certain amount, and these benefits may only be available after you have met your deductible for the calendar year. 

The sex therapist needs to be able to diagnose you with a specific mental health condition so they can report to your insurance company that they are providing a medically necessary healthcare service.  This could be something specific to sexual health like erectile dysfunction or something related to the emotional impact of the sexual health problems you are having, like depression. 

What can a sex therapist help you with? 

Sex therapists can provide support for a range of scenarios like: 

• A monogamous couple that is thinking of opening up their relationship, they want help strengthening their communication and strategizing about boundaries.

• A female patient has been experiencing sharp pain in her vulva every time she attempts penetrative intercourse since her C-section last year.  She is in pelvic floor therapy to treat the cause of her pain, but wants to explore some strategies for revitalizing her sex life.

• A couple have a sex life they enjoy, but one partner recently disclosed a kink that the other partner isn’t into at all.  They are wondering how to manage this desire discrepancy in a way that is “fair” to both of them.

• A polyamorous adult is struggling with increased conflict between two of their metamours (people who have a partner in common but don’t date each other).  The hinge partner (the partner in common) feels confused about what their role is for managing the conflict between their partners and wants some support exploring this.

• A male patient experiences erectile dysfunction when he has partnered sex, but not when he masturbates.  His urologist has told him the problem is psychological.  He feels frustrated and confused about what to do next, and wants some help.

• A patient who was sexually assaulted last year has been struggling to experience orgasm since the assault.  She feels safe and happy in her current relationship and frustrated that she can’t “get there” she is worried there is something wrong with her.

• A couple with a toddler find that their sex life has diminished since becoming parents.  They are attracted to each other, but they feel like “ships in the night.”  Their new role as parents has left them with little time and energy to feel like sexual beings, and they want to find a way to tap back into that energy. 

What happens during sex therapy? 

A sex therapist will probably start by asking you what brings you to their office.  They’ll invite you to share as much or as little about this as you’re comfortable. Sex therapists often use the PLISSIT model, which involves: 

P: permission giving:  The therapist will share that they ask all of their patients about their sexual health, and will ask permission to introduce the topic. 

LI: limited information: The therapist will address specific questions the patient has, and try to correct any major myths and misconceptions. 

SS: Specific suggestions: The therapist will ask some questions about your sexual health and if you want, offer some specific strategies. 

IT: Intensive therapy: If the therapist thinks you would benefit from psychotherapy to address your concerns, they will offer this. They might work with you themselves, or suggest a colleague who has expertise in your specific project. 

What kinds of questions will a sex therapist ask you during an appointment? 

Sex therapists might ask questions about: 

• Your experience with sex ed when you were growing up

• Your early sexual experiences

• Your partner preferences

• Your safer sex practices

• Your current sexual activity

• Your experience with dating and relationships

• Your experience with marginalization, discrimination, and sexual violence

• Your experiences with pain during sex

• Your experience with things like low desire, difficulty achieving or sustaining and erection, and difficulty experiencing an orgasm

• Your experience with shame, guilt, or conflicted feelings about your sex life 

How can a sex therapist help with sexual problems? 

Education: sex therapists will help you fill in the gaps in your sexual health education in a way that is pleasure-positive.

Technology and other tips: sex therapists might have suggestions for specific bedroom techniques, positions or equipment that can help make sex more comfortable, pleasurable or adventurous. 

Communication: sex therapists can help you talk to your partner(s) about intimacy, and find ways to problem solve barriers to having sex that is worth having. This could involve understanding how your drive differs from that of your partner, and how to seduce them in a way that makes them feel seen and heard. 

Understanding: sex therapists can help you explore your own erotic template, the unique set of things that are turn ons for you.  This might involve thinking about the origin of these fantasies, how to unplug them from any guilt or shame you are accidentally holding, and how to authentically express them in your real life. 

Considering sex therapy? 

Whether you're facing a specific challenge or just want to explore your sexual wellness, reaching out to a sex therapist can be a powerful step. Contact us today to learn more or schedule a consultation.