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Intimacy and Sex Therapy

What is Intimacy?

The word “intimacy” is often used as a euphemism or code word for sex, because some people are uncomfortable discussing sex more frankly.  When I use the word “intimacy,” I mean physical and/or emotional closeness.  This can range from trusting another person enough to share your most personal thoughts and feelings with them to physical acts such as hand holding, cuddling, kissing and sex.  But couples can be intimate without sex, and they can have sex without being emotionally intimate.

What are Intimacy Problems?

A lack of intimacy generally means that a couple is not close or they do not show affection to one another.  They might not even talk to one another.  I have seen couples who have been together for 5 or more years and are not even aware of each others’ beliefs about religion.  More commonly, I see couples who spend too much time at work, value their roles as parents over their roles as friends or partners in a relationship, are bored with one another, or have so much resentment that they just avoid each other all together.  Some couples can see the problem developing and seek out help early before it turns into a big problem.  Others wait until it feels like it’s too late.  If you lack emotional intimacy in your relationship, the treatment is Marriage Counseling.  If the problem is sexual in nature, the treatment is referred to as sex therapy.  As you will see below, there really isn’t a difference between the two, aside from the therapist requiring two different sets of knowledge or expertise.

What does it mean to have problems with low Sexual Desire?

A problem occurs when there is a mismatch between the desire of one partner and the other.  This means that the problem is more of a problem in the relationship than a problem within you.  Typically, one partner either resists sexual activity (sometimes including a simple peck on the cheek or even hand-holding) and the other partner relentlessly pursues sex or some kind of physically intimate activity.  The pursuer often becomes frustrated and even angry, and the resistant partner feels annoyed and/or guilty.  Of course, there are many ways that this problem can show itself, and each couple is different.  But regardless of where the problem lies and how it manifests itself, it causes a lot of heartache and suffering, and it puts a enormous strain on relationships.  And it can play out as a deterioration of the relationship as a whole.  To understand how it is treated you should first understand another relevant concept: sexual aversion.

What Causes Low Sex Desire and Sexless Marriages?

A lot of people come to me complaining that their partner will not or does not want to have sex with them, or that they have no libido or have lost their sex drive.  This can be caused by many things, including but not limited to:

  • Feeling as if sex is a chore or an obligation
  • Performance anxiety
  • A lack of closeness or intimacy
  • A tense or troubled relationship
  • A stale relationship or regimented sexual patterns
  • Unattractive behaviors on the part of one’s partner
  • Past traumatic experiences with sex
  • When couples become conditioned to feel anxious about the topic because of past arguments
  • Stress, exhaustion, or mismatched schedules
  • Conflicting priorities
  • Negative associations with, anxiety about, or discomfort with the idea of sex
  • Negative body image or self-consciousness

What sex therapy is NOT First, let me ease your mind. Nothing weird is going to happen in my office. Most people are quite nervous and uncomfortable talking with a stranger about sex. Even if that stranger is a doctor. I am not going to show you pictures of anything (well, maybe a picture of a neuron). I am not ever going to touch you or ask you to touch your partner in my presence. We don’t chant in my office. Or dance. I will not ever suggest that you do anything that you find immoral. I strongly oppose the use of sexual surrogates, as they are untrained, unlicensed, unproven, and in my mind, unethical. Now that we have that out of the way…

What is sex therapy?

Sex therapy is the same as Cognitive Behavioral Therapy, but focused on a specific set of problems and diagnoses related to sex, intimacy, and relationships. It requires specialized knowledge on the part of therapists, which is not unique to sex therapy. When psychologists, social workers, and counselors treat problems such as depression, panic attacks, grief, and ADHD, they are ethically required to have specialized knowledge of those problems as well, although they often do not.

In addition to being a Licensed Clinical Psychologist, I am also certified as a Sex Therapist through the American Association of Sexuality Education, Counselors, and Therapists. (AASECT). I primarily identify as a psychologist because sexual problems require a strong background in areas in which psychologists excel – assessment; learning, motivation, and conditioning theory; anxiety, depression, and OCD treatment; and the scientific evaluation of what works and what doesn’t.

As noted above, sex therapy is really no different from the treatment of anxiety, depression or OCD. I personally only use the term “sex therapy” and “sex therapist” because it helps people find me and it indicates to them that I have the expertise to help them with their specific problem(s).

What happens in sex therapy?

My job is to help you solve a problem or achieve a goal. Sex therapy is delivered in a similar fashion to the way that marriage counseling or anxiety treatment is delivered. We begin by working together to define the problem, figure out what is causing and perpetuating it, and come up with clear, achievable goals. We then develop a plan for solving the problem, and you will be given advice and specific steps for moving toward your goals.

I will assess your views about sex, various aspects of your relationship, anxiety that you have about sex and intimacy, events that precipitated the problem, your partner’s behavior, your own behavior and thinking patterns, etc. Neither you or your partner will be blamed for the problem, but both partners are usually asked to make some changes. Therapy resembles marriage counseling, and like marriage counseling, positive change and fulfillment are emphasized. 

What I treat

In addition to Marriage Counseling, my primary specialty is Sexual Desire Problems (formerly Hypoactive Sexual Desire Disorder or Sexual Aversion Disorder). But I also have expertise in treating Erectile Dysfunction, Fetishes, and the psychological aspects of Vaginismus (uncontrolled tightening), and Sexual Pain. I will never ask to look at or touch any part of you, unless I need to see whether anxiety is making your fingers cold. I will refer you to a medical doctor or a physical therapist for any physical treatments.

Some additional information about sex therapy

Sex Therapy involves an equal focus on both partners’ perspectives and goals.  If you want your partner to back off, and I will help them do that.  But if you need your partner to engage more with you, I will help them find their own motivation for doing so.  This way, both partners end up truly getting what they want.

Therapy for both desire and aversion problems are not just about helping the low-desire partner.  It is also about helping the high-desire partner learn to put less pressure on the low-desire partner, which is often a primary cause of the problem.  In other words, putting less pressure on your partner can increase your chance of getting what you  want more often.  Unfortunately, if all you do is back off, more times than not, your situation will not get better.  That is where people need help from someone who specializes in this problem.