Although some people with sexual problems improve over time without professional help, sometimes therapy is necessary. In fact, sometimes alleviation of sexual problems is a side effect of successful psychotherapy for general psychological problems (Hoyer et al., 2009). However, seeking therapy is often a difficult step. A community medi­cal practice found that, when asked, many men reported various sexual problems, but none had previously sought professional help (Rosenberg et al., 2006).

What Happens in Therapy?

Many people are apprehensive about going to see a sex therapist, so it can be helpful to have some idea about what to expect. Each therapist works differently, but most therapists follow certain steps.

During the first appointment, the therapist will help the client (or clients, if a couple) clarify the problem and his or her feelings about it and identify the client’s goals for the therapy. The therapist will usually ask questions about when the problem began, how it has developed over time, what the client thinks caused it, and how she or he has already tried to resolve it. Sometimes the therapist may only need to provide specific information that the client lacks or to reassure the client that his or her thoughts, feelings, fantasies, desires, and behaviors that enhance personal satisfaction are nor­mal. On the other hand, some people may benefit from permission not to engage in certain sexual activities they dislike.

Over the next few sessions (most therapy occurs in 1-hour weekly sessions), the therapist may gather more extensive sexual, personal, and relationship histories. The therapist will likely obtain informa­tion about medical history and current physical functioning to make any necessary referrals for further physical screenings. During these

Sexual Difficulties and Solutions

sessions, the therapist will also explore whether the client has a lifestyle conducive to a good emotional and sexual relationship and determine whether she or he has problems with substance abuse or domestic violence.

Once the therapist and the individual (or couple) more fully realize the nature of the difficulty and have defined the therapy goals, the therapist helps the client understand and overcome obstacles to meeting the goals as the sessions continue. The therapist often provides psychoeducational information and gives assignments, such as masturbation or sensate focus exercises, for the client to do between therapy sessions (Althof, 2006). Successes and difficulties with the assignments are discussed at subsequent meetings. In some cases personal emotional difficulties or relationship problems are causing the sexual issue, and various forms of intensive therapy are necessary.

Therapy is terminated when the client reaches his or her goals. The therapist and cli­ent may also plan one or more follow-up sessions. It is often helpful for a client to leave with a plan for continuing and maintaining progress.