By Christina Mathieson, LMFT #115093, founder of My Mental Climb.
The two most common misunderstandings about sex therapy:
- That something physical happens in the room. It doesn't. Sex therapy is just talk therapy.
- That you have to be in some kind of crisis to come in. You don't. "I'd like our sex life to feel more alive" is a perfectly valid starting point.
This is an orientation: who comes in, what happens, what to look for in a sex therapist, and how to tell if it's the right fit.
Who Comes In
Most sex therapy clients are working on one (or several) of these:
- Mismatched desire, when partners' interest in sex doesn't line up
- Functioning concerns: difficulty with arousal, erection, orgasm, or pain with intercourse
- Sexual anxiety: performance pressure, "in my head" experiences, avoidance
- Recovering desire after a life event like postpartum, perimenopause, illness, treatment for depression, or grief
- Working through how a sexual past is showing up now (abuse, neglect, religious shame, an early bad experience)
- Relationship structure questions, especially for couples in non-monogamous, polyamorous, or kink-involved relationships who want a therapist who already gets the context
You don't need a "diagnosis." Curiosity about your own sexual life is enough.
What Happens in a Session
The first session is intake: history, current concerns, and goals. For sex therapy specifically, we add a sexual history, which covers your sexual development, formative experiences, current functioning, and anything you've already tried. This isn't to dig for trauma; it's so we can work from a real picture rather than a guess.
From session two onward, what happens depends on what's there:
- For couples, work often involves structured between-session conversations and, when appropriate, gradual reintroduction of intimacy practices (done at home, never in the room).
- For individuals, the work blends education about sexual physiology and response, CBT-based work on the cognitive layer, and processing whatever's held underneath.
- When trauma is part of the picture, we coordinate with EMDR or somatic approaches before deep sex-therapy work.
Sessions are typically 50 minutes, weekly to start, often shifting to biweekly as things move.
How Sex Therapy Differs From Couples or Individual Therapy
This is one of the most common questions I get, and the difference is more about focus than about format. Couples therapy works on the relationship as a whole, including communication, conflict, attachment, and shared goals. Individual therapy works on what's happening inside one person, including anxiety, depression, trauma, identity, and life transitions. Sex therapy works specifically on sexual functioning, satisfaction, intimacy, and the ways those intersect with everything else.
In practice, there's substantial overlap. Couples therapy often touches on sex, individual therapy often touches on identity and relational patterns, and sex therapy often surfaces broader relationship dynamics. The right starting point depends on what's most pressing for you.
If you're not sure which to start with, that's normal. Most people come in with one frame and end up working in two or three layers as the picture gets clearer. The first session is the place to figure out where to begin.
What Counts as a Trained Sex Therapist
This is worth knowing because the field is loosely regulated. Anyone can list "sex therapy" as an interest area. Substantive training looks like one or more of:
- Certification or training through the American Association of Sexuality Educators, Counselors, and Therapists (AASECT)
- The Buehler Institute's Comprehensive Sexology Program (where I trained)
- Post-graduate sexology coursework through accredited programs
If you're vetting therapists more broadly (sex therapy or otherwise), finding the right therapist: key considerations and warning signs is a useful next read.
Common Misconceptions Worth Naming
A few things sex therapy is not:
It's not surrogate partner therapy. That's a separate, much rarer practice with very different ethical and clinical considerations. Sex therapists do not engage in any physical contact with clients, and we don't refer to surrogate partner therapy as a routine option.
It's not religious or moral counseling. We don't tell you what your sexual life should look like. We help you work toward what you want it to look like, within whatever framework matters to you.
How to Know If It's the Right Time
If sex has become a topic you avoid in your own head, with your partner, or with your other healthcare providers, that's a good time to come in. If you've been quietly living with something for years that you've never had a chance to put words to, that's also a good time. There's no minimum threshold of distress required.
Common Questions People Ask Before Starting
Will I have to do anything physical or homework that feels awkward?
You'll never be asked to do anything in session beyond talking. Between-session homework, when it's used, is collaborative and matched to what you're ready for. For couples, this might be a structured conversation, a non-sexual touch exercise, or reading something together. Nothing is mandatory, and the pace is yours.
Is sex therapy covered by insurance?
Sex therapy is typically billed under mental health benefits, the same as any individual or couples therapy. We're in-network with Lyra; for other insurance, Mentaya helps you use out-of-network benefits. See our billing and insurance page for current details on what's covered and how the math works.
What if I'm single? Can I still do sex therapy?
Yes. Individual sex therapy is a substantial part of the practice, and a lot of valuable work happens entirely solo. Whether you're working on past sexual experiences, current functioning, or your relationship to your own desire, none of that requires a partner to be in the room.
How long does sex therapy usually take?
It depends on what you're working on. Specific concerns like performance anxiety or a single-issue communication problem can resolve in 8 to 12 sessions. More layered work, especially when trauma or long-standing patterns are involved, often takes longer. We'll be honest with you about timeframes once we understand the picture.
Is sex therapy confidential, given how personal the topic is?
Yes, with the same legal and ethical confidentiality that applies to any licensed therapy. The exceptions are the same as in any therapy (immediate safety concerns, mandated reporting), and they're explained clearly at intake. Nothing you share in session goes anywhere outside it.
Book a free 15-minute consult and we'll talk about whether sex therapy is the right fit. There's no pressure either way.
Related from My Mental Climb: Sex therapy · Mindfulness techniques and sex therapy · Free 15-minute consult
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Last clinically reviewed: by Christina Mathieson, LMFT #115093.
