A Beginner’s Guide to Sex Therapy

Low Section Of Woman Holding Pillow While Sitting On Bed
Photo-Illustration: by The Cut; Photo: Walter Ciceri / EyeEm/Getty Images/EyeEm

Maybe you’re in a long-term relationship in which the desire has dwindled and falling asleep to a mocktail of tart cherry juice and magnesium glycinate is easier than mustering the will to have sex. Perhaps you’re new parents having a hard time getting it on or sex has just become so painful that even the thought of intimacy sends you into an anxiety spiral.

While most have no qualms about seeking medical attention for an illness or injury, it’s all too common for people to sweep sexual dissatisfaction under the rug, often out of shame that they’re experiencing it to begin with. “The No. 1 question I get, in one iteration or another, is ‘Am I normal, or am I broken?’” says Dr. Kate Balestrieri, a licensed psychologist, sex therapist, and founder of a California-based sex- and couples-therapy practice. (Never mind that sexual dysfunction is extremely normal, and more than 40 percent of women are bound to experience it at some point or another.)

This is where a certified sex therapist can step in. As mental-health professionals who have completed extra training focused on sexual health, sexuality, and pleasure, sex therapists can help you with anything from anxiety to sexual dysfunction, including trouble orgasming or pain during penetration. They can help you have better sex, whether you’re struggling with a particular crisis or because you simply want to feel more confident in the bedroom. Here, what to expect and how to find the right therapist, according to experts and people who have done it.

How do you know if you need sex therapy?

Matt Lundquist, a couples therapist and founder of Tribeca Therapy, says all good therapists should theoretically be able to offer support in the realm of sexuality, but in reality, some shy away. After actress and filmmaker Merle O’Neal documented her feelings of discomfort around sex and her body for BuzzFeed back in 2020, she decided to see a sex therapist to unpack them. She had seen an individual therapist for a year but felt resistance when she tried to bring up anything sex-related. “The therapist stopped me and said, ‘Just so you know, this isn’t my specialty. I’m not a sex therapist,’” says O’Neal. “I was like, ‘But I should still be able to talk about it.’ I could see they were uncomfortable.” So she found a specialist.

How are sex therapists different from other therapists?

Certified sex therapists are licensed mental-health professionals who complete additional coursework in sexual health, including training in anatomy and physiology, intimacy skills, and pleasure enhancement. They essentially offer regular therapy with a dose of sex education, facilitate intimate discussions about sex and your goals around it, and often provide take-home exercises that you’ll practice at home and analyze in-session.

Where should I start looking for a sex therapist?

Start with referrals from trusted members of your network. If you’re already in couples or individual therapy, ask the therapist for suggestions. If you have a therapist you used to see whom you trust, you can also ask them or friends who have gone to sex therapy and had positive experiences. A doctor or gynecologist might also be able to provide a reference.

If you’re still coming up empty-handed, you can try the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), the largest and most reputable certifying board for sex therapists. It’s a streamlined database with more than 600 licensed sex therapists and can help you find someone qualified in your area.

What should I look for in a therapist?

Be wary of providers who tack sex therapy on to a laundry list of offerings. Thomas, whose name has been changed for privacy, has been married for 17 years and has seen a number of couples and sex therapists for mismatched libidos, tells the Cut, “If everything else listed isn’t sex-related, that’s the person you’re going to get — somebody who sort of dabbles.”

Beyond AASECT credentials, Lundquist says other signs of a capable provider might include teaching positions in their field or sex-therapy-related published work. Another good sign? A sex therapist who is booked and busy. “The restaurant in town with the line out the door is probably a good restaurant,” he says.

You should also just find someone you feel comfortable with and who makes you feel as if nothing is TMI or off the table. While feeling “some shame and embarrassment is natural,” O’Neal says, “it shouldn’t come from the person you’re talking to.”

What kinds of questions should you ask to make sure they’re a good fit?

“Talking about the most sensitive and intimate areas of your body, there’s a lot going on,” says Erin, who saw an AASECT-certified provider for faltering libido and perimenopause. “Approach it like dating: If someone doesn’t make you feel safe in their practice, you can leave. And you should.” Sex therapist Todd Baratz recommends asking providers whether they’ve successfully treated couples or individuals who have been in the same boat. Press for details. What did their treatment entail, and what were the results? What parts of treatment weren’t helpful? If you want a therapist with a trauma-informed background, ask if they have one. If you’re looking to explore kink, for example, ask your prospective therapist if they have experience working in that niche.

Above all, Baratz emphasizes making sure you and your therapist connect on a personality level: “I want to feel like they’re relatable and down-to-earth — not robots, not ‘Mhm-mhm, how does that make you feel?’ all day.”

What can I expect in a sex-therapy session?

“People have wild thoughts about what sex therapy is. I’ve even been asked if I had sex with my clients. That was on a date — we did not make it to date two,” Baratz says. Contrary to popular misconceptions, however, sex therapy is talk therapy. “It’s not a space where clothes should come off or sex should be happening,” says Lundquist. “It’s a symbolic space where you talk about sex.”

You can expect to start off sessions with an intake, in which you and your therapist discuss everything from what your sex life looks like now to your relationship dynamics and family history. “It’s a lot of the who, what, when, and why questions about sex, and after that I ask about family histories and different traumas and things like that,” Baratz says. “Because often, sex is not just about sex. It’s about the anxieties we have.” Sex therapists will offer feedback and analysis as well as a significant amount of homework for you to try out at home, which can include masturbation, touching exercises to help connect with your partner, scheduling sex, using dilators to help adjust to the sensation of penetration, or trying different kinds of lubricant. Homework can also involve cognitive exercises, like reading self-help books or novels with characters facing similar struggles.

O’Neal says her sex therapist had her look at her vulva and body in a mirror to help her explore her body and normalize the parts of it she had formerly shied away from: “She was like, ‘I just want you to think of your vulva and your vagina as being as normal as your elbow. You don’t have to be super-excited about it, but you have to at least accept it and not pretend like it’s not there.’”

Do you need to try individual or couples therapy before sex therapy? Are they prerequisites?

There are no prerequisites for sex therapy, though some clients do benefit from unpacking the emotions it may bring up in the context of individual therapy, particularly when it comes to histories of sexual trauma and assault. Still, Thomas recommends going to regular or couples therapy beforehand as a kind of checkup, “just to see if you’re having underlying issues with past relationships.” He also suggests trying couples therapy if you’re in a relationship and your primary issues aren’t sexual. “If you’re having issues as a couple, sex therapy isn’t going to fix them,” he says. “It’s hard to have a good sexual relationship if you don’t trust each other and aren’t getting along.”

What are red flags to watch for?

Because talking about sex with a stranger is such a vulnerable act, you never want a sex therapist who makes you feel unsafe or uncomfortable. “It shouldn’t be painful,” says Baratz. “It’ll stir up emotions, but it really shouldn’t be excruciating.” Steer clear of cold or shaming providers and providers who impose their own religion or value systems on you or who don’t seem to understand their own biases around sex. Lundquist says to also be wary of sex therapists who are “super-heteronormative” and lack understanding of concerns around sex, gender, and other intersections of identity, all of which can speak to a potential conservatism about how sex can happen.

As with any kind of therapy, a sex therapist with a lack of boundaries is also something to look out for: providers who dominate too much of the session talking about themselves or their own sex lives, even if it’s an attempt to connect with patients. Balestrieri also warns against sex therapists who practice outside their own scope, offering medical advice instead of referring you to appropriate providers or giving advice about topics you can tell they have limited expertise about, like a particular fetish they can’t handle questions about. “If a therapist isn’t familiar with kink and you happen to be a practiced kinkster, you might be able to hear some of the stretches of their knowledge,” says Balestrieri. In those scenarios, it’s best to speak up. “It’s okay to push back,” she says.

On the flip side, what are some green flags?

Therapists who are warm and engaging, who are genuinely curious about their clients’ histories and don’t brush past clients’ hang-ups or traumas around sex, and who check in and refer clients to other providers when they need something that’s out of their scope are all positive signs. You also want someone who assigns homework and pushes you to make sure that you’re practicing whatever’s being discussed in therapy. And, of course, someone who appreciates sex in all its weirdness. “Somebody who can hang with a fetish, who can hang with the idea that certain individuals or couples might get off in ways that might not be conventional. Sex is a domain where we need to be able to invite in some of our wonderful uniqueness and strangeness,” says Lundquist.

How do you know if therapy is working?

You should see tangible improvement in your sex life after successful therapy, whether that means feeling more connected with your partner or more comfortable naked. “Sex therapy isn’t always a quick fix,” says Balestrieri. But even if you haven’t accomplished your end goal yet, she says you can still measure improvements by establishing progress markers, or “memorable milestones,” along the way. For example, if you began the process unable to achieve penetration, eventually being able to insert the smallest dilator might be a worthwhile milestone.

“People can get a sense of Okay, I came in feeling incredibly disgusted by my partner, and now I kind of desire them and we have sex here and there and I feel comfortable naked with them,” says Baratz. While the specific timeline of improvement depends on the issues you’re working through, Baratz says you should expect to see some improvement within three to six months, provided you’ve been getting quality therapy and doing your homework. The six-month mark in particular is generally a solid benchmark, though issues that stem from major sexual trauma usually take longer to address.

When it’s not working, you’ll know that, too. For instance, if you came in with a desire discrepancy that’s only getting worse, that’s a clear indication the therapy isn’t helping. “You can get a sense of This is working versus I hate them even more. I don’t want to touch myself; I want to scream looking in the mirror,” says Baratz.

What if I don’t have a partner?

You don’t need one! Plenty of clients go to sex therapy solo; couples aren’t the default. “This is a cliché line, but the most important relationship we have sexually is with ourselves,” says Baratz. Whether you’re not dating but want to work through personal sexual hang-ups or you are dating and are navigating starting different sexual relationships, a sex therapist can offer helpful guidance. Balestrieri frequently sees clients who are in relationships but prefer solo therapy anyway. “Going to sex therapy on your own can give you tremendous insight into how you approach sex, what it means to you, what you like about it, how to incorporate fantasies or practices that perhaps you are a little bit nervous to share with a partner or have had a negative experience with that you want to change,” she says.

Is sex therapy covered by insurance?

It’s difficult to find a sex therapist who takes insurance, but Balestrieri advises calling your insurance company and asking how it might cover a prospective treatment. It’s uncommon for insurance to cover sex therapy, but the odds are higher if you’re seeking help for a specific diagnosis, such as female orgasmic disorder or delayed ejaculation. For the most part, Lundquist says you can almost certainly expect to pay out of pocket for care. Fees range from therapist to therapist but are generally between $150 to $400 an hour.

Can I ask for a reduced fee?

If you can’t afford the going rate, ask a therapist if they offer a sliding scale. “Be frank about what you can afford, and see if the therapist can make room for that,” Balestrieri says. Some may be able to, and some won’t.

If a provider you really want to work with doesn’t offer a sliding scale, Lundquist suggests saying something like, “I’m sure you’re worth it, but that’s a bit prohibitive. Is there any flexibility on fee?” If you’re willing to come at a less busy time for the therapist, like 11 a.m. on a weekday rather than on a weeknight, Lundquist says that could also help. “You’re trading a bit of inconvenience to fill a slot that might not be so busy in their calendar,” he says, “and it’s a way of respecting their value.” And, of course, it never hurts to let a provider know why you’re excited about them in particular. “Therapists can be flattered as well as anybody,” says Lundquist.

I can’t afford sex therapy. What are my other options?

If one-on-one therapy isn’t in your budget, Balestrieri says group sex therapy is also an option. The format varies from practice to practice, but generally participants can expect to talk about their individual challenges and receive feedback from the sex therapist as well as from other participants; as with one-on-one therapy, you may also get somatic exercises — mindful movement that helps you release physical tension and gain body awareness to try out at home. Some group therapy can center on a specific theme, like a group for sex-abuse survivors or for those suffering from pain during sex.

Some sex therapists offer online courses, which tend to be lower cost and can incorporate some kind of group-session component. It can also be beneficial to do some reading on your own. Baratz recommends Mating in Captivity: Unlocking Erotic Intelligence, by Esther Perel; She Comes First, by Ian Kerner; It’s Not Always Depression, by Hilary Jacobs Hendel; and Come As You Are, by Emily Nagoski.

What if I don’t reach my goal?

You should still walk away from sex therapy feeling more comfortable than when you started. “The No. 1 thing sex therapy gave me was hope that I have the ability to enjoy this,” O’Neal says. “I can’t say it made everything easier, but it definitely made me feel like I had control and that there were steps forward.”

A Beginner’s Guide to Sex Therapy