How Therapy Can Help Your Sex Life

It's not just two bodies intertwined between the sheets. Minds get tangled, too.

Video: Erectile Dysfunction
By + More

When Stephen Braveman suggested to his wife that they needed sex therapy, he did so with trepidation. He worried he'd "be seen as a pig who only wants sex." Even though he's a practicing sex therapist himself, his marriage wasn't immune from the intimacy challenges that face so many couples. In his case, says Braveman, of Monterey, Calif., his upbringing during the "free love" 1960s in California put him at odds with his wife's native German culture. "It's just not in her personality to be verbally expressive in the bedroom," he says. Still, she agreed to join him in therapy, and the couple has "made progress."

Sex, of course, isn't purely physical. Intertwined between the sheets are not only two bodies but also the emotional and psychological aspects of their personalities. Each person's upbringing, culture, religion, and previous experiences can have an impact on sexuality, says Helen Virginia Bush of Boca Raton, Fla., president of the American Association of Sexuality Educators, Counselors and Therapists. Add in idealized perceptions of what one's sex life should be, plus a heap of hormones, and it's no wonder we sometimes need a little help.

What brings a couple to sex therapy can range immensely. The issue might be mismatched sex drives, past abuse, her difficulty reaching orgasm, or his obsession with Internet pornography. "Anywhere from 35 to 50 percent of people struggle with long-term sexual difficulties over the course of their lives," says Derek Polonsky, a psychiatrist and sex therapist with Harvard Medical School. And lest you should be misled, men are not the only creatures who want sex more often than their partners do. In fact, "He never wants to have sex" is as frequent a refrain from female patients as the equivalent is from men, experts agree. "Many couples break into a power struggle where it's intercourse versus nothing," says Barry McCarthy, a longtime Washington-based sex therapist and professor of psychology at American University. " 'Nothing' is going to win."

So what goes on behind the therapist's closed door? Misconceptions abound, which might explain why many people neglect to seek help. For example, therapy consists of talking only; performing sexual acts in front of the therapist is viewed as unethical. McCarthy's job regularly involves adjusting clients' expectations that every effort should mimic a steamy Hollywood lovemaking scene. Research suggests that even among happily married couples with functional sex lives, fewer than half of encounters are "ideal," meaning both want sex, are turned on, and are orgasmic.

Coaching couples to develop sexual skills—or work around physical limitations caused by illness or medical treatments—is often a key component of sex therapy. Homework assignments might include finding enjoyment in dates that are sensual but not necessarily sexual or having erotic experiences that don't culminate in intercourse. A great many try penetration before both partners are sufficiently turned on, which can leave one or both feeling frustrated or lacking confidence. Intercourse, stresses McCarthy, should begin "at high levels of arousal."

While it's often twosomes who seek sex therapy, individuals—whether in a relationship or not—can benefit as well. But if just one member of a couple opts in, the work may prove more challenging. "Sex therapy is most effective," says Bush, "if you have both parts of the system [engaged]." Polonsky has seen clients who have been unproductively told by their partners, "I've never had this problem with anybody else; you go and get it fixed." Polonsky requests that the resistant partner meet with him at least once.

The effectiveness of sex therapy, in fact, often depends on clients' willingness to commit to the work involved—often without seeing instant payoff. Bush recalls a couple who'd had premarital sex, which caused the wife significant guilt. Intercourse became incredibly physically painful for her, and she and her rather controlling husband ultimately divorced. Years later, Bush received a thankful message from the woman, who explained that she was finally enjoying sex—with a new partner.