Stereotypes and myths about sex therapy can lead to unrealistic expectations and assumptions that can have a negative effect on therapy. Unfortunately, the taboo associated with this subject may cause people to shy away from asking the questions they want to know about sexuality, gender, and sex therapists. Some questions may seem uncomfortable or even comical, but this is a common reaction to discussions about sex, sexuality, and gender. I will address a few of them here. (Note: I only represent my own opinions and interpretations. I do not speak for or deliberately intend to represent the views of any other person, profession, or organization. When necessary, citations are listed to reference source material).
What is sex therapy?
Sex therapy can be defined as the assessment, diagnosis, and treatment of sexual dysfunctions and disorders by a licensed mental health professional [1]. This is the definition I use when referring to sex therapy, unless otherwise noted.
Why is sex therapy a specialty?
A general discomfort with sexuality in various cultures has resulted in limited required training in sexuality within the healthcare professions, including mental health[1]. One example: a licensed marriage and family therapist (LMFT) in Washington State has a master's or doctorate level degree that meets the extensive state criteria for education in marriage and family therapy. One course in human sexuality is required for this license [2]. Therapists who specialize in sex therapy usually supplement their license with additional training specific to sexuality and gender, just like any other specialty. Even LMFTs without a specialty in sex therapy can (and do) take additional courses in sexuality and gender topics.
Certification in sex therapy is not mandatory. Clients with primary treatment needs for a sexual disorder or dysfunction may be referred to a sex therapist by healthcare professionals. Certification in sex therapy is available (but not required) through national organizations such as the American Association of Sex Educators, Counselors, and Therapists (AASECT).
Do you treat sexual compulsions (sometimes referred to as sex addiction)?
Yes. There are many who report having out-of-control or compulsive sexual urges, thoughts, and behaviors. These can definitely be addressed in therapy. Like society, psychology has an unfortunate history of using biased beliefs about morality to label sexual behavior. For example, homosexuality was diagnosable as a mental disorder until 1973, which led to improper stigmatization and ineffective treatment of an entire population of people who were told that their sexual orientation meant they were mentally unstable [3]. The high probability of the misuse of the term 'sex addiction' and insufficient evidence to support an official separate diagnosis are a couple of reasons why it is not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and other diagnostic manuals.
A client's experience of problematic sexual behaviors is valid and treatable, including those they consider to be compulsive or out-of-control. I believe every effort should be made to engage in treatment focused on addressing the perceived problem instead of engaging with clients based on a label that has been used to shame, blame, or impose a certain set of moral standards onto clients.
Do sex therapists have sex with their clients?
No. We are actually asked this question a lot, perhaps because of our focus on sexuality and assumptions about people who are comfortable with talking about sexuality and gender. In addition to being unethical for licensed therapists, sex therapists do not provide sexual services to their clients and should not be requested to do so. Licensed healthcare professionals are bound by a code of ethics that forbid sexual relations with current and former clients including the American Psychological Association code of ethics. Additionally, sex therapists who are certified by AASECT or working within the guidelines provided by AASECT, adhere to an additional code of ethics specific to the sexuality field. Once again, the answer to that question is no.
Can I talk about issues that are not related to sex in session?
Absolutely. Most sex therapists are licensed mental health professionals. I am a licensed marriage and family therapist trained in couples, family, and individual therapy.
Do you know all the fetishes, sex toys, and terminology? Have you tried them?
People in the sexuality field (including sex therapists) are often asked questions that are unlikely to be asked of professionals in other fields. I attribute it to a lack of education and general knowledge about sex therapy and sex therapists. Due to the stigma around talking about sex, and my commitment to psychoeducation, I try not to discourage people from asking questions out of genuine curiosity.
For example, when talking about different types of lubricants, a client may ask, "Do you know anything about this kind of lubricant? Have you tried it?" In this context, those questions may be asked because it is a natural line of questioning outside of the therapeutic environment. It may be asked before the client has a chance to realize that they just asked the therapist about the kind of lubricant they use in their personal lives. In my therapy sessions, I keep this in mind so as not to shame a client for asking a question.
No one knows everything about sex and gender. I may have more sexuality-focused education and training, but I am unfortunately not a walking sex encyclopedia. My personal sex life is not relevant to therapy. I am more than happy to assist in obtaining additional resources and providing referrals, as requested. That said, I have no tolerance for questions asked with the intent to diminish or disregard the education and professionalism of sex therapy/sex therapists, including questions that are asked specifically of those who identify as female.
Do sex therapists prescribe medication for sexual functioning?
Only a licensed medical professional such as a psychiatrist, medical doctor, or nurse practitioner can assess for and prescribe medication. However, you may authorize your therapist to collaborate with your health care team about your treatment plan.
Why should I pay for therapy? Can't I just talk to a friend?
It is a common misconception that talk therapy is no different than talking to a friend or a family member. However, when you attend therapy, you are paying for a service from a clinical professional with extensive training.
For example, licensed marriage and family therapists (LMFT) in Washington State are required to have several years of training, which includes classroom and hands-on training. One must complete a master's or doctorate degree from an accredited university in marriage and family therapy. Additionally, 500 supervised clinical hours with an approved mental healthcare provider are required before graduation. Post-graduation, licensed therapists are required to pass a state licensing exam and complete 3,000 hours (including 500 direct clinical hours and 100 hours of supervision) within two years [3]. A specialty (such as sex therapy or play therapy) usually requires additional supervised hours of clinical training and certification. For the duration of their career, continuing education training is required to ensure therapists' skills are current. Specifics on my training and experience can be found here.
Are my sessions confidential?
Yes. Confidentiality is crucial to therapy. As a mandated reporter, I am legally and ethically bound as a licensed therapist to report suspected abuse of a child, developmentally disabled individual, or a vulnerable adult; interruption of intentional plans to commit suicide; intervention against serious threatened harm to another person (including knowledge that a patient is HIV positive but the patient is unwilling to inform others with whom they are intimately involved); and if required by court order or other compulsory process.
I can disclose your information if you sign a written authorization (informed consent), allowing me to release information to another person or agency, such as your psychiatrist or physician. I take every precaution to safeguard patient information as outlined in the Health Insurance Portability and Accountability Act (HIPAA) of 2006, a federal law which contains provisions for the transmission of health information. I am not required to report citizenship or immigration status. We will speak about this in more detail during your session.
What is sex therapy?
Sex therapy can be defined as the assessment, diagnosis, and treatment of sexual dysfunctions and disorders by a licensed mental health professional [1]. This is the definition I use when referring to sex therapy, unless otherwise noted.
Why is sex therapy a specialty?
A general discomfort with sexuality in various cultures has resulted in limited required training in sexuality within the healthcare professions, including mental health[1]. One example: a licensed marriage and family therapist (LMFT) in Washington State has a master's or doctorate level degree that meets the extensive state criteria for education in marriage and family therapy. One course in human sexuality is required for this license [2]. Therapists who specialize in sex therapy usually supplement their license with additional training specific to sexuality and gender, just like any other specialty. Even LMFTs without a specialty in sex therapy can (and do) take additional courses in sexuality and gender topics.
Certification in sex therapy is not mandatory. Clients with primary treatment needs for a sexual disorder or dysfunction may be referred to a sex therapist by healthcare professionals. Certification in sex therapy is available (but not required) through national organizations such as the American Association of Sex Educators, Counselors, and Therapists (AASECT).
Do you treat sexual compulsions (sometimes referred to as sex addiction)?
Yes. There are many who report having out-of-control or compulsive sexual urges, thoughts, and behaviors. These can definitely be addressed in therapy. Like society, psychology has an unfortunate history of using biased beliefs about morality to label sexual behavior. For example, homosexuality was diagnosable as a mental disorder until 1973, which led to improper stigmatization and ineffective treatment of an entire population of people who were told that their sexual orientation meant they were mentally unstable [3]. The high probability of the misuse of the term 'sex addiction' and insufficient evidence to support an official separate diagnosis are a couple of reasons why it is not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and other diagnostic manuals.
A client's experience of problematic sexual behaviors is valid and treatable, including those they consider to be compulsive or out-of-control. I believe every effort should be made to engage in treatment focused on addressing the perceived problem instead of engaging with clients based on a label that has been used to shame, blame, or impose a certain set of moral standards onto clients.
Do sex therapists have sex with their clients?
No. We are actually asked this question a lot, perhaps because of our focus on sexuality and assumptions about people who are comfortable with talking about sexuality and gender. In addition to being unethical for licensed therapists, sex therapists do not provide sexual services to their clients and should not be requested to do so. Licensed healthcare professionals are bound by a code of ethics that forbid sexual relations with current and former clients including the American Psychological Association code of ethics. Additionally, sex therapists who are certified by AASECT or working within the guidelines provided by AASECT, adhere to an additional code of ethics specific to the sexuality field. Once again, the answer to that question is no.
Can I talk about issues that are not related to sex in session?
Absolutely. Most sex therapists are licensed mental health professionals. I am a licensed marriage and family therapist trained in couples, family, and individual therapy.
Do you know all the fetishes, sex toys, and terminology? Have you tried them?
People in the sexuality field (including sex therapists) are often asked questions that are unlikely to be asked of professionals in other fields. I attribute it to a lack of education and general knowledge about sex therapy and sex therapists. Due to the stigma around talking about sex, and my commitment to psychoeducation, I try not to discourage people from asking questions out of genuine curiosity.
For example, when talking about different types of lubricants, a client may ask, "Do you know anything about this kind of lubricant? Have you tried it?" In this context, those questions may be asked because it is a natural line of questioning outside of the therapeutic environment. It may be asked before the client has a chance to realize that they just asked the therapist about the kind of lubricant they use in their personal lives. In my therapy sessions, I keep this in mind so as not to shame a client for asking a question.
No one knows everything about sex and gender. I may have more sexuality-focused education and training, but I am unfortunately not a walking sex encyclopedia. My personal sex life is not relevant to therapy. I am more than happy to assist in obtaining additional resources and providing referrals, as requested. That said, I have no tolerance for questions asked with the intent to diminish or disregard the education and professionalism of sex therapy/sex therapists, including questions that are asked specifically of those who identify as female.
Do sex therapists prescribe medication for sexual functioning?
Only a licensed medical professional such as a psychiatrist, medical doctor, or nurse practitioner can assess for and prescribe medication. However, you may authorize your therapist to collaborate with your health care team about your treatment plan.
Why should I pay for therapy? Can't I just talk to a friend?
It is a common misconception that talk therapy is no different than talking to a friend or a family member. However, when you attend therapy, you are paying for a service from a clinical professional with extensive training.
For example, licensed marriage and family therapists (LMFT) in Washington State are required to have several years of training, which includes classroom and hands-on training. One must complete a master's or doctorate degree from an accredited university in marriage and family therapy. Additionally, 500 supervised clinical hours with an approved mental healthcare provider are required before graduation. Post-graduation, licensed therapists are required to pass a state licensing exam and complete 3,000 hours (including 500 direct clinical hours and 100 hours of supervision) within two years [3]. A specialty (such as sex therapy or play therapy) usually requires additional supervised hours of clinical training and certification. For the duration of their career, continuing education training is required to ensure therapists' skills are current. Specifics on my training and experience can be found here.
Are my sessions confidential?
Yes. Confidentiality is crucial to therapy. As a mandated reporter, I am legally and ethically bound as a licensed therapist to report suspected abuse of a child, developmentally disabled individual, or a vulnerable adult; interruption of intentional plans to commit suicide; intervention against serious threatened harm to another person (including knowledge that a patient is HIV positive but the patient is unwilling to inform others with whom they are intimately involved); and if required by court order or other compulsory process.
I can disclose your information if you sign a written authorization (informed consent), allowing me to release information to another person or agency, such as your psychiatrist or physician. I take every precaution to safeguard patient information as outlined in the Health Insurance Portability and Accountability Act (HIPAA) of 2006, a federal law which contains provisions for the transmission of health information. I am not required to report citizenship or immigration status. We will speak about this in more detail during your session.
1 - Binik, Y.M. and Hall, K.S.K. (2014). Principles and practice of sex therapy (5th ed.). New York, NY: The Guilford Press.
2 - Washington State Legislature. WAC 246-809-121.
3 - Moser, C. (2013). Hypersexual disorder: Searching for clarity. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 20(1), pp. 48-58.
2 - Washington State Legislature. WAC 246-809-121.
3 - Moser, C. (2013). Hypersexual disorder: Searching for clarity. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 20(1), pp. 48-58.