The following is an interview between Brittany Senseman, LPC-S, and Melanie Sutton, LPC. Melanie is a trained sex therapist with a Christian world view. In this interview, Mel answers some basic questions regarding the purpose and process of sex therapy.
Brittany: What exactly is sex therapy?
Mel: Sex therapy can take a lot of different forms. Typically a couple will come in when they’re experiencing some type of sexual dysfunction, and we will work together to come up with some solutions for whatever dysfunctions they’re experiencing. If it’s a married couple, we’ll do some marriage work, relationship work, and make sure they’re communicating well and handling conflict well. So it might look like your typically counseling session. But then we weave in exercises that they take home and do together to overcome whatever hurdle they’re facing.
Brittany: It sounds like it is a lot more about the relationship part, and then the physically intimacy piece of it gets added on. Is that accurate?
Mel: Yes! Sometimes we’ll have a couple that comes in that has a really solid relationship, and with those couples we can jump right in to the sex homework. There’s a protocol for each different issue that comes up, sexually speaking. It depends on what they come in with.
Brittany: I have to assume when people come in, they’ve got to be embarrassed and uncomfortable. How do you get them comfortable?
Mel: You know, I get it because whenever I started out on this I was uncomfortable as well. I had to get myself really used to using sexual language and talking about body parts and talking about things that happen during intimacy. So, I think part of it is how we approach anything that makes us anxious. I think some of it is just exposure.
I think the first benefit of coming in and talking about things that make you feel embarrassed is that it will push them out of their comfort zone a little bit. But by the end of the first session, they realize, “We survived that, and it wasn’t so bad; and maybe we can do that again.” I think that exposure and talking about it can really help decrease that anxiety and help overcome the awkwardness of talking about your sex life.
Brittany: So it’s almost just like talking about it is the therapy.
Mel: Yes, sometimes it’s like that for couples. Especially if the couple isn’t talking about sex in the first place, just showing them and modeling for them that it’s something they can talk about it … sometimes that’s all they really need and then they can work on things on their own.
Brittany: How can a couple know when it’s time to come in for sex therapy?
Mel: It’s totally subjective. But there are a few issues I want to point out that would be important to specially to see a sex therapist. Any sexual dysfunction: female vaginal pain disorders… when they’re experiencing a tremendous amount of pain during sex, or if it’s really raw or stinging. Male erectile dysfunction or ejaculatory disorders. Those are things to work on in therapy.
Something that I see really often is decreased arousal or decreased desire. Or a discrepancy in desire or arousal. Like if one partner says “I want to have sex five times a week” and their spouse says, “I would be OK with having sex just once every other week.” Then we can sit down and work through some of that as well.
If there has been sexual trauma or abuse, then that’s something that will come up in intimacy later on down the road, and that’s another specific issue that I would highly recommend someone coming in for. Any compulsive sexual behavior… pornography or anything looking outside of the relationship for sexual satisfaction.
A couple may have several different issues, but if they find themselves fighting about sex more often than the other issues, then that’s typically going to be a couple where sex therapy would be beneficial because in their minds sex has become a centerpiece of the problem in the relationship. Sometimes that can be the first domino that we knock down as a way of creating change for them.
Brittany: I do couples counseling, and sex has to be a part of that conversation – and like you say, a lot of times, sex becomes the identified problem. I see a lot of the discrepancy issue where one person has a higher desire than the other and that tends to be what everyone is fighting about. When, like you say, there’s almost always some other underlying issue that’s creating the barrier; but it’s just easier to talk about sex and get mad about it.
Mel: Right, exactly! Sometimes it’s just easier to point back to sex than it is to uncover some of the other parts of the relationship that they may feel uncomfortable with or vulnerable about. I think sex is one of those areas that’s easy to just point the finger, and a lot of times it can give the couple some ammo whenever they’re coming into session.
Brittany: What are common myths you’ve had to debunk as a sex therapist? It seems like people have the impression that they’re going to be prescribed some odd, kinky, uncomfortable kinds of things to do which makes them really reticent to go.
Mel: One of the funniest things I’ve heard is people worrying they’re going to have to do something sexual in the office – that I’m going to grade them, or watch their technique! There’s no removal of clothing in the office! I don’t show techniques or anything like that. There may be a time when we do an exercise, but it wouldn’t be anything you wouldn’t feel comfortable doing in front of a large group of people. We definitely keep it very safe.
Now, I will say that there are many “flavors” of sex therapy out there. My training as a Christian sex therapist definitely approaches this process through the lense of how we can have this intimacy within the bonds of a covenant relationship and honoring the sexual ethic formed by biblical beliefs. That creates for couples more of a sense of safety because they know I’m not going to send them to go watch pornography or read racy novels or do anything that would be outside the boundaries they’ve become comfortable with.
Brittany: Is that a main distinguishing feature between what your services and typical sex therapy?
Mel: Yes. In your typical office, if someone comes in and let’s say a woman has been breastfeeding and her hormones are out of whack and her sex drive is almost zero, which is very normal for a new mom. What a typical sex therapist might prescribe is anything to increase sexual stimuli and definitely pornography would be a tool and reading racy novels and things like that.
The neat thing about what I get to do is think outside the box and tap into “holy imagination” and allowing our brains that God has given us to be a playground for our intimacy and creating new ways of finding that sense of excitement with your spouse and not having to look outside the marriage for that.
Brittany: What is a typical amount of time a person or couple might expect to be in therapy?
Mel: Typically expect six months to a year. We start out seeing each other frequently and once we put homework exercises in place, we see each other less frequently to give the couple time to do those exercises.
It’s all about what effort you put into the process outside the counseling office. We can talk about it all year long, but are they actually doing the homework exercises and changing their behaviors? I’m not a behavioral therapist, but some of the protocols are so behaviorally oriented that it requires a lot of follow through. So, I would say it takes a motivated couple for the therapy to work.
Brittany: This is great information! Thank you for your time!
Mel: Thanks for having me!