What is sex therapy - and is it right for you?
What Is Sex Therapy - and What Actually Happens in a Session?
By Helen Wyatt LMFT, CST | AE Collective | Sex & Relationship Therapy in Chicago, Illinois, and Colorado
In our first meeting, a lot of clients have the same general questions:
Are you going to assign us homework to have sex?
Are we going to touch each other in session?
What actually goes on in sex therapy?
These are great questions - and the fact that people are asking them tells us something important: despite becoming more prominent in our modern media, what actually occurs in sex therapy is still sometimes deeply misunderstood. And because of that, a lot of people who could genuinely benefit from sex therapy never reach out.
So here’s the honest rundown of what sex therapy is, what it isn’t, and what you can actually expect.
What Sex Therapy Actually Is
Sex therapy is a highly specialized form of psychotherapy. You sit with a licensed therapist trained in sexological science and talk about your experiences, feelings, and concerns related to your sexuality and/or sexual relationship(s). Sex therapy is talk therapy, focused on a part of life that most people never get real support around.
A sex therapist isn’t just a therapist who happened to take one workshop about the topic of sex (it is an unfortunate fact that sexuality - despite being an innate part of being human - is not a part of general therapist training). Certified sex therapists (CSTs) have specialized training and certification through AASECT - the American Association of Sexuality Educators, Counselors, and Therapists. CSTs have deeply explored their own beliefs and values around sex, so that they are able to show up without judgment and offer you care, regardless of what you bring into the room, using research-backed sexological science and treatment techniques.
Not all therapists are trained to talk about or work with sexuality. If sex is part of what you want to address, it’s always okay to ask a clinician directly about their background and comfort with sexual concerns.
What Happens in a Session
Whether you come in solo or with your partner, your therapist will guide you through a thorough exploration of your concerns and your goals for therapy - along with histories that help build the full picture: mental and physical health, family of origin, relationship experiences, and your history with sexuality.
If you’re a couple, you’ll likely be seen both together and separately, depending on the issue you’re treating in therapy. Your therapist needs to understand where you are, where you want to be, and what you’re willing to put into the work so that they can collaborate with you to help you meet your goals.
Here’s what you can count on: your therapist will go at the pace of the person with lower desire - you’re not required to have sex while engaging in sex therapy. Rather, you work with the therapist to discover the preferences and experiences around pleasure and pain of all persons in the therapy room. You will always be fully clothed in session, and you’ll never be asked to do anything that makes you feel uncomfortable. Consent is of utmost importance here. There is no physical touch between therapist and client. You will also never be asked to touch your partner in a sexual way during a session. That said,…
It’s More Than Just Talking - But Not in the Way You Think
Sex and relationship therapy tends to be more directive than standard talk therapy. That means you’ll likely be given homework between sessions. This might look like reading or watching something relevant to what you’re working on, observing your own feelings and patterns throughout the week, or body-based or touch exercises to do privately, on your own or with a partner.
The work that happens between sessions matters enormously. Think of it as an 80/20 split: about 20% of the work of sex therapy happens in the therapy room, and 80% of the work depends on how you engage with it in your everyday life. Progress in sex therapy comes when you are curious, dedicated to actualization, and prioritize how you engage with what you learn in therapy at home.
It’s About a Lot More Than Sex
In sex therapy, you’ll spend a lot of time talking about things that seem unrelated to sex. And that’s completely intentional.
Everything outside the bedroom has the potential to follow you into it - the argument you had earlier in the week, the stress of getting the kids out the door, the way you learned to handle conflict and relate to others growing up. Sex therapy requires conversations about communication, attachment, body image, family dynamics, boundaries, and how you came to understand yourself as a sexual and relational person in the first place.
This context isn’t a detour; it is the work. And when it comes together, people often find that sex and relationship therapy benefits far more than just their sex life. It often compliments or heals what other therapies couldn’t.
Is It Effective? Does Your Partner Have to Come?
The research on sex therapy is clear and consistent - it works, particularly when clients engage honestly and take the work seriously outside of sessions.
As for whether your partner needs to be there: not necessarily. Many people come to sex therapy solo and do meaningful, transformative work. That said, if you’re in a relationship, change tends to happen most powerfully when the whole relationship unit is engaged - even if your partner is only present in conversation rather than physically in the room. Relationally created wounds are best healed relationally, after all. A good sex therapist will be straightforward with you if they believe your concerns would be better addressed with your partner involved.
What People Come In For
Sex therapy can help with a wide range of concerns, including:
Mismatched desire: when you and your partner want very different things, or when desire has faded and you’re not sure why
Feeling addicted to or out-of-control of sexual behaviors: challenges with chronic masturbation, watching porn or other sexual imagery compulsively, or visiting sex workers at a compulsive or harmful frequency
Sexual functioning concerns: difficulty with arousal, orgasm, or erection
Sexual pain: whether rooted in the body, the mind, or both
Sexual anxiety or shame: often tied to messages absorbed from religion, culture, or past experiences
Navigating identity and desire: exploring questions about your sexuality in a genuinely affirming space
Recovering from sexual trauma: healing at your own pace, with knowledgeable, relational support
Reconnecting after a life transition: new baby, health changes, grief, or anything that’s shifted the dynamic
You don’t need to be in crisis to come into sex therapy. Some people arrive with a specific concern; others just know something isn’t quite working and want help figuring out what. Both are valid starting points.
Ready to learn more or take the next step?
At AE Collective, I offer warm, judgment-free, expertly led, collaborative sex and relationship therapy for individuals and couples - in person in Chicago, or online across Illinois and Colorado. Reaching out is often the most challenging part of the process. I try to make our exploration and work as interesting and fulfilling as is possible.
Contact me to schedule a free consultation.
