Effective sex therapy for couples requires a combination of basic sex therapy and relationship/marital counseling. It makes no sense to see two counselors to address relationship issues. A board certified (preferably AASECT) sex therapist is rigorously trained to solve sexual and relationship problems. I am certified by four national boards.
Most marriage counselors are NOT trained to solve sexual problems. Most of them have had a course in human sexuality, if that. The brand of therapy you choose depends on the training and certifications of the therapist. Generally, marriage counselors see a couple together, without seeing them individually. The problem with this approach is that it fails to completely identify the nature and causes of the problems. This is because partners tend to cover up or not be totally forthcoming when they are together from the start of therapy. I would never fully know the exact nature of problems if I did not see a couple individually for a session each before seeing them together.
Another reason for seeing each partner separately is to respect the privacy and confidentiality of each. I am aware that many marriage counselors refuse to keep anything private from a partner, but I do not find this realistic or effective. I encourage each couple to find an acceptable line between privacy and secrecy. This line varies for different couples. We all deserve some privacy. Marriage (whether heterosexual or same sex) is part of a person’s life, but it cannot be all of his/her life.
Each therapist has some theoretical approach. Mine is Cognitive Behavioral Therapy (CBT), along with medical consultations with doctors, when appropriate. I use Dr. John Gottman’s insights along with my intensive background in CBT and sexology. My approach is quick and accurate to identify and treat a variety of sexual and relationship issues. Most of my therapy is short-term. I take weeks to months—not years—to solve most dilemmas.
When a couple come to me from a doctor or therapist referral, or from an Internet search, I explain how I would deal with the problems they have. I assign homework and home-play and I make specific suggestions to improve communication and the relationship. I am direct and I use humor. People lower their anxiety when they laugh at themselves, and with their partner. I am definitely not a “how do you feel?” therapist. I deal with emotions, but I do not take a passive approach.
Often a couple comes in to solve a sexual issue where one or both think the problem is completely one partner’s issue. This is usually not the case. For example, a couple may come in because the man has trouble getting and keeping a good erection, but I often quickly identify that the woman has never been fully aroused enough to have an orgasm, or that she has painful intercourse. I focus on solving both problems along with any mental, relational and medical/physical issues that may be causing the problems.
Each case is different. I utilize my extensive background in sexology to deal with sexual issues. I think out of the box. I do not have the boilerplate mentality that each problem has to be solved in one way out of a textbook. I use my imagination and humor to develop a sound treatment plan. I then hone the plan as I experiment and find new information.
I work with quite a few couples from India. Due to their lack of sex education, I often address erection issues along with vaginismus (tightening of the vaginal muscles due to fear of pain, actual pain and emotional pain) or painful intercourse as long as they complete the treatment plan. I have been successful with these couples as long as they complete my treatment plan.
I usually see couples weekly until I make significant progress, and then I go to every two weeks. In some cases, I do every two weeks from the start. It all depends on the severity and complexity of the problems. Again, there is typically not one problem. There usually are two or more problems to solve. I piece together the puzzle so I can totally solve the issues.
Not all sex and couples therapists give homework and/or home-play, but I can solve the problems quicker this way. Couples counseling should not be limited to smoothing over real problems with band-ids.
I see some couples who have some communication and relationship problems, but not any sexual issues. My approach works well for these couples too. In some cases, I refer to an individual therapist to complement my treatment plan for the couple. When there are medical issues, I refer to physicians or work with the physician a person already has. The team approach is extremely effective when the presenting problems call for it.