The Secrets of Sex Therapy

She (we’ll call her Janice, age 41) was unhappy with her husband (we’ll call him Pat, 42). After several years of Pat’s inability to sustain an erection, Janice started blaming herself and lost confidence in her sexual appeal. She began to doubt the value of their marriage and decided to see a sex therapist for counseling.

After her first few sessions with Rhode Island-based certified sexologist and sexuality educator Megan Andelloux, Janice gained the courage to ask Pat to see a doctor to rule out a medical condition. That turned out to be the case: He had weight issues that were affecting blood flow, leading to erectile dysfunction. At Andelloux’s suggestion, the couple began to explore intimacy not based solely on erections while Pat worked to lose weight and improve his overall health. For Janice and Pat, it was a new beginning. For Andelloux, it was another day at the office.

Most couples begin dealing with relationship issues in traditional therapy settings with marriage counselors or therapists, Andelloux says. But sometimes this professional may not be educated in a range of issues connected to sexuality, so a referral to a sex therapist is in order.

While trained therapists, such as those with a master’s degree in social work (MSW), receive a number of hours of sexuality training as part of their overall education, accredited sex therapists build on already-existing backgrounds in social work, medicine, psychology, or specific graduate work in sexuality.

The American Association of Sexuality Educators, Counselors, and Therapists, the field’s central body of oversight and accreditation, requires 90 hours of graduate-level coursework plus supervised clinical hours.

What happens in the offices of certified sex educators, counselors, and therapists is all about talk, much like any other form of therapy and counseling. “We are not allowed to touch our clients, nor would we consider doing so,” Andelloux says. “No sex ever takes place in a sex therapist’s office.”

Her office is a venue where clients struggling with any range of sexual issues can feel completely safe and candid in discussing and working on these problems. “It could be about two people having different levels of desire,” she says. “We see everything from couples dealing with aging and changes in sexual functioning to women dealing with rape trauma in their sex lives to men being concerned and ashamed about the content of their fantasies. It’s a large range.”

As a sex educator, Andelloux’s work focuses on far-ranging conversations about sex and sexuality, including a typical technique in traditional therapists’ offices: homework. For couples having trouble with intimacy (a common problem), Andelloux may prescribe what’s called purposeful touch. “I might advise 10 minutes a day of touching one’s partner that doesn’t lead to sex,” she says.

For Janice and Pat, the homework continues. “They’re still together,” Andelloux says. “He’s lost weight and gained confidence, and they’re working on their sex lives as well as their marriage.”