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Everything You Ever Wanted to Know About Sex Therapists

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Sex: such a vexing topic. Fireworks one moment, shame and embarrassment the next. Harnessing this exasperating spirit so that it brings nothing but happiness can often mean talking to a trained professional, but is that a conversation you’re capable of having? Coach correspondent Louise Chunn, founder of welldoing.org (opens in new tab), a site that helps you find a therapist, explains how it’s done.

Grandparents used to say “into every life some rain must fall”. You’re probably more familiar with “shit happens”. Sometimes you find you just can’t cope and – often haltingly – some of you opt to seek help. That’s what therapy and counselling is all about: talking to a neutral person about events or habits that are worrying you.

But what do you do when sex is a big part of your problem? You’re not having it; you’re having it so much you fear you might be a sex addict; you only want it when you’re high or inebriated; you only want it with someone you wish you didn’t; you feel you’re not big enough, can’t last long enough, fear you won’t orgasm; you want it, but you can’t do it. The varieties of worries are many, but the places to go for help seem to be few. It’s just too private to talk about with a stranger, isn’t it?

And yet sex is something that everyone is miraculously supposed to be expert at and ecstatically satisfied by. Such pressures cry out for an outlet to discuss your feelings and the way you see relationships. And it doesn’t cost much more than a personal trainer: from £40 a session, delivered either in person or online.

Men find it more difficult than women to confront sex and relationship issues, but pushing your feelings down inside you is rarely the answer. As Andrew Reeves, chair of the British Association for Counselling and Psychotherapy (BACP), says: “Men have emotional needs in exactly the same way as women. The difference is that women have been allowed to seek support for them while men have been silenced through male gender roles, adding feelings of shame and isolation to the emotional mix.” Here, then, is an array of advice from a number of experts on how to talk about sex with a therapist – and why it matters.

You don’t have to know what’s wrong with you to see a therapist

Speaking to a therapist is not like seeing a dentist: it can take more than simply opening your mouth and lying back on a couch to get to the bottom of what has brought you there. They don’t expect you to self-diagnose or ’fess up everything on the first session, either. They’re there for the long run, helping you to understand your feelings and why you do the things you do.

Owen Redahan, a cognitive behavioural therapy (CBT) counsellor working in Canary Wharf, said he saw John*, 26, for three weeks before he got around to saying what was troubling him. “He was acutely embarrassed and ashamed that he was watching porn, and this was causing problems in his relationship,” Redahan recalls.

“He was happy to chat about the intimacy side with his girlfriend, but there was no mention of the porn he was watching.” Those weeks weren’t wasted, though; they enabled John to feel comfortable enough to open up to his therapist. “Once we got to the core of the problem, we could actually explore why he used porn,” says Redahan. “Then we could introduce changes that led to him developing his relationship and reducing his porn-watching.” Like most therapists, Redahan is non-judgemental: “I’m only against porn when it gets in the way of people living their lives fully – which it sometimes can.”

You need to find a therapist who you really feel comfortable with

Given the thousands of therapists around today, it’s not always easy to find the right one for you. And of course it’s even more difficult when the subject matter is so sensitive, triggering worries that the person you’re talking to will think there’s something “wrong” with you sexually. However Rima Hawkins, a sex therapist working in Chelsea and Fulham, tells me that 95% of her clients are male and that it doesn’t take long for them to feel safe talking about everything, from drug use to extra-marital relationships and seeing prostitutes. But many men, understandably, prefer to talk to a man about sexual issues, particularly if infidelity is part of the story.

There’s no definite rule here – in fact, one therapist believes the choice can come down to which parent they found it easier to discuss personal subjects with. People who want to explore their sexual identity may want to find a gay therapist, which they can find via welldoing.org (opens in new tab) or pinktherapy.com (opens in new tab), but many therapists of either gender will be open to discussing this area.

Redahan recounts seeing 19-year-old Simon for the first time: “I had just started taking his personal details when he burst into tears, saying he just had to tell someone that he was bad and different, and that he hoped I wouldn’t judge him.” If you don’t feel reassured or understood, you should be honest about it. Therapists are used to not every client working out; a key to successful therapy is a strong relationship, so it’s in their interests not to continue with someone who isn’t a good match.

You have to give therapy some time to work

For one thing, it often takes a while for you to really get talking. So how many sessions will you need, then? It’s hard to answer, as there are so many variables. Sometimes it’ll be a few sessions; some see their therapists for years. Hawkins had one client who had been satisfied with casual encounters, often involving Viagra and porn, for years but now wanted a relationship. “At first he couldn’t get an erection in a dating scenario,” she says, “so I explained to him all about foreplay and tenderness, whereas his primary desire was penetration and orgasm.

“I gave him permission to try to do it differently, and slowly he found that it could work.” She initially saw him every week for four months, reducing their sessions to fortnightly. Now they meet each month. “He’s worked very hard on himself,” she observes, “though he’s not yet found a partner.”

Seeing a sex therapist or general counsellor 

You can choose between seeing a sex therapist or someone who is more generally trained as a therapist or counsellor – though the experience will probably be different.

The relationship between you and your therapist is more important than their experience or qualifications, but it’s worth knowing the difference in approach to counselling so that you look in the right place for the best therapist for you. Sex therapists are specialists in the study of human sexuality, whereas therapists and counsellors (especially those who include CBT) are generalists, used to talking more broadly.

Hawkins, for example, is a member of the College of Sexual and Relationship Therapists (COSRT) and has worked as a dedicated sex therapist for 18 years. The majority of her clients see her to deal with erectile dysfunction, and although they range from the age of 18 to into their fifties, there is a large cohort in their twenties. COSRT’s directory (opens in new tab) is a good place to start looking for qualified sex therapists.

Simon Hudson, on the other hand, is an integrative (meaning he uses a variety of styles of therapy) counsellor working in central London. He sees a lot of men – of all ages – who come to talk about their feelings around intimacy. Most therapists have experience in talking to clients about relationships, and those who specialise in it will often have extra training in interpersonal relationship counselling.

Everyone feels embarrassed talking about sex, but these people really have heard everything before

It’s not easy for anyone to talk about something as private as sex to a stranger. But it’s not as awkward as you might imagine.

You can use whatever language works for you; you don’t have to be polite. Therapists are professional in their approach and it’s part of the process for you to be as absolutely honest as you can. “Many men feel they will be judged failures if they have to talk to someone about sex,” says Redahan. “But you’d go to a doctor if you had a physical problem – so why not go to a counsellor if you are stuck with negative feelings that you can’t overcome?”

Ben Douch, a psychotherapist who uses a mindfulness-based approach and works in east London, says he’s found some clients will initially be much happier talking about problems in a relationship. “That’s an opportunity to push the blame onto someone else,” he observes. “It’s safer than accepting there is something about themselves that they don’t like.” But sometimes it’s only after a few sessions that the deeper stuff will come out: an affair, or problems with feeling undesired/unnoticed. While not wanting to stereotype, Douch has also noticed that “gay men are more comfortable with the subject, whereas straight men identify sexual prowess more with masculinity. So to talk about it means being vulnerable, and that is something [straight] men don’t enjoy.”

Therapists aren’t there to stop you doing things, but to help you understand yourself better

All the therapists I spoke to mentioned that many young men are now experiencing problems with porn addiction, particularly if it’s been available to them from a pre-teen age. We may know it’s a common practice, but it’s still a secret, hidden-away behaviour often shielded by shame. And that’s not a healthy feeling.

“The problem with porn,” explains Hudson, “is that it keeps you away from your needs. It gives you a dopamine reward but with no intimacy reward, so it’s ultimately unsatisfying. It fits in with our short-termist approach to so many things, but ultimately most men want a relationship – with connectedness, intimacy, trust and the status that brings, so they need to break away from their reliance on porn.”

*Client confidentiality is protected therefore names have been changed