Sex therapists seem to be everywhere these days — on chat shows, online, on the radio, and even in your high street. You may be living next door to a sex therapist and not even know it! So, what is a sex therapist, what do they do, and can they help with erectile dysfunction? Here are some of the answers to your questions. Only you can decide if a sex therapist is appropriate in your particular case, and this chapter should help you to make that decision.
What is a sex therapist?
A properly qualified sex therapist — and that’s the only type you should consider using – is likely to have a background in relationship counseling, psychiatry, psychology or clinical social work. They may even have a medical background, but they will have received specialist training in order to be recognized as a sex therapist qualiﬁed to advise individuals or couples on problems within their relationships that are sexually related in some way.
Put simply, a sex therapist treats sex problems with science and an open mind, in the specialized manner that is often required in such cases. Personal opinion and experience are not usually likely to inﬂuence the way they work with their patients, and each new case is approached with an open mind, but also with several scientiﬁcally proven solutions in mind. Although the treatment is tailored to the individual, it is based on years of experience in the ﬁeld, and scientiﬁc back up. Most sex therapists have a much more detailed knowledge of human physiology as it is affected by sexuality, and all the processes the body goes through before, during and after sexual intercourse. In fact, a really good sex therapist may have more expert knowledge of this particular area of physiology than many medical practitioners.
A sex therapist is not a snake oil salesman or a prostitute or escort under a more job polite description. It‘s not like in some pom ﬁlms, where the sex therapist jumps into bed with one, two or several of his or her clients, and everyone’s sexual
problems are resolved as if by magic with the cameras rolling. In fact, most sex therapy revolves around talk and advice. In a few — very rare — cases, a surrogate partner therapist may be used. We’ll take a look at that option later in this chapter, because it’s something totally different.
What to expect from a sex therapist
In the initial session, your sex therapist will want you to do most of the talking, so he or she can determine whether the cause of your problem is physical, psychological or a combination of both. Questions will be asked, and you’ll need to answer them as fully and as honestly as you can. Depending on the exact details of your personal case, it may take more than one session to complete this important first step.
This detailed assessment will help the sex therapist to formulate a plan of action for you, and decide how often you need to attend therapy sessions. The therapist may suggest that your partner attends some or all of the sessions with you, or you may attend on your own. You will not be expected to do anything against your wishes, and the atmosphere should be relaxed and friendly, to allow you to open up to your therapist and work together to solve your problems.
Part of the therapy will involve doing exercises at home between the sessions, either alone or with your partner. These will be formulated to help you understand your body and your sexuality, and enhance your self conﬁdence and sexual awareness. You should remember — and your therapist should remind you regularly — that sex is supposed to be an enjoyable, pleasurable experience, and the sessions will be geared towards that achievement. Some of the exercises may not seem to have much point, but remember this is a scientiﬁc treatment program, and there is a reason for everything you are asked to do. If you don’t understand something, ask your therapist to explain, because you need to work together on this if you are to get maximum beneﬁt from the sessions.
You will need to provide a detailed history of your sex life to date. This is not salacious interest on the part of the therapist — it’s an excellent way to pinpoint when problems started, and in some cases, why. You’ll also need to talk about masturbation, because in a lot of cases of erectile dysfunction — particularly those involving younger men — there is no problem achieving or maintaining an erection, it just happens when they are with a partner. This may mean that performance anxiety is exacerbating your problem, and your therapy will be geared to address this, and any other issues that transpire during the initial assessment.
Everything you say to your therapist is and will always remain conﬁdential, so be open and honest, and answer all questions as fully as you can. Talking in this way helps you to understand why you are having problems maintaining erections, as well as teasing out long—buried stuff that you thought you’d forgotten but which may still be impacting on your life, even after many years. It’s all very cathartic, and it can help your therapist to formulate the most appropriate and effective program for your needs. Don’t be ashamed and hold back on anything — it may be a cliche, but your therapist really has heard it all before. He or she will not be shocked by your revelations, so open up, and let it all out in the presence of someone who is highly trained to help you work through your problems and move on with your life and your sex life.
Although the atmosphere is meant to be relaxed and intimate, inviting conﬁdences, the therapist will not touch you, because what goes on in the ofﬁce is based around talk, not bodily contact. It’s against the professional code of practice to touch clients, and this will be explained to you at the outset. It makes sense when you think about it — it would be only too easy for the client to develop an unhelpful and inappropriate attachment to his therapist, given the nature of the secrets he’s shared.
The therapist is also likely to ask about your general life outside the bedroom, because he or she needs to build a picture of you as a complete person in order to offer the best counseling and advice for your particular case. Although sex therapy is a science like medicine, the difference is that it’s not also tailored to the individual. There may only be one way to remove an appendix, for example, but there are countless ways to approach the treatment of erectile dysfunction within the scientiﬁc framework.
And it may be that some of the exercises you are asked to do have nothing to do with sex at all. Nevertheless, they are geared towards helping you to attain a more satisfying sex life. For example, if it emerges that you have a poor body image, you may be advised to join a gym or fit some extra exercise into your routine. Or it might be suggested that you try to build more intimacy with your partner in various ways — maybe by having an evening where you sit and hold hands, talk to each other about your dreams for the future or even touch or caress each other, without attempting to have sex.
One very successful way to re-establish lost intimacy is to lie in bed together naked, touching and cuddling, but not attempting foreplay or sex. Often, the simple act of removing the pressure to have sex can be a big help in solving issues of erectile dysfunction, so the therapist may even advise you not to have sex for a certain period of time, and if this is the case, you should respect the advice, because he or she has been dealing with this sort of stuff for a long time. When the therapist thinks you are ready to have successful and fulﬁlling sexual intercourse, you will be the ﬁrst to know!
Other ‘homework’ may include non—sexual touching exercises and recommended reading. The whole process is geared to help you to get to know yourself and your sexuality on a deeper level, so that you can understand what has happened to you and why, and then work through it and take your relationship to the next, happier and more intimate level.
Many sex therapists say that the saddest thing about their profession is that couples and individuals treat sex therapy as the ‘last chance saloon,’ when so many of the problems they are presented with can be resolved very quickly and simply, even though they initially appear insurmountable to their clients. Most sexual problems do have a solution, but too often, anger and resentment has built up and it may be too late to save the relationship.
Relationship counseling is a natural part of sex therapy — your therapist needs to determine whether something in the relationship is causing or contributing to your erectile dysfunction. In fact, you can expect to cover all aspects of your life and feelings with your sex therapist. Very often, talking about things that have been bottled up for too long — especially things related to sex and intimacy — is a liberating experience for the client, and a revealing one, and you may often discover ways to improve your situation, simply by talking about them with someone who is giving you their undivided attention. If other methods have failed, maybe sex therapy is worth some of your time and effort in your quest to conquer erectile dysfunction.
Surrogate Partner Therapy (SPT)
Surrogate Partner Therapy was the brainchild of American sex experts Masters 8: Johnson, and it’s been around for around 60 years, although it’s only recently become more mainstream, due to media attention and movies like The Sessions, which dealt with what has up to know been seen as something that’s little short of legalized prostitution, or an affair with a veneer of respectability. However, used in the right way and for the right people, it can help men to overcome erectile dysfunction.
A sex therapist does not offer sex as part of the client’s therapy. Indeed professional ethics and common sense decree that no body contact should take between client and therapists during consultations. However, another aspect of sex therapy, which is usually used in conjunction with conventional therapy sessions involve using a surrogate partner who will perform sexual and intimate acts with you as part of the therapy. Not every client is a suitable candidate for this, and not every case is appropriate for surrogate partner therapy.
This is no regular affair, and it’s nothing like an encounter with a prostitute — it’s a businesslike arrangement in which a highly trained surrogate will work with a client to address and treat their sexual problems in conjunction with conventional sex therapy. At the same time, the surrogate and client form a real relationship and develop the level of intimacy and sharing that is necessary for the surrogate to help the client to achieve his sexual aims and enjoy happy, healthy and fulﬁlling relationships in the future.
The surrogate may or may not interact sexually with the client, but when that happens, it’s not about pleasure in the moment — it’s about dealing with the sexual problem, and helping the client through it by educating him about his body, his sexual and emotional responses and using both structured and unstructured exercises and techniques to overcome the issue of erectile dysfunction.
However, SPT is not all about sex — it’s concerned with the whole spectrum of relationships — how you feel about your body, and how you can have a much better, happier and long term relationship with your life partner or partners, with sex, but most of all, and most importantly, with yourself. It may be good to talk, but sometimes talk isn’t enough, and people need practical experience in overcoming sex-related issues — if you want to put it a particular way, they need to be shown, rather than advised, how to overcome their sexual difﬁculties.
Working with a trained partner who is deeply aware of their own sexuality as well as having a specialized knowledge about giving and receiving pleasure can be very rewarding for some people. In the case of erectile dysfunction, this approach may work where others have failed, because there is no pressure to please, even if the pressure is self—imposed. This is a learning experience, and the client will be shown techniques and talked through why some things work and others do not.
SPT is a combination of scientiﬁcally developed sexual exercises aimed at rethinking the attitude and developing couples communication so that everything in
the bedroom is geared towards mutual pleasure and enjoyment, rather than seeing orgasm as the end objective, and New Age and Eastern thinking on self-awareness and relaxation techniques. You learn to connect mind and body through meditation, relaxation and breathing exercises, combined with practical techniques designed to enhance enjoyment for both partners. This brings about a new self-confidence that is not conﬁned to the bedroom but radiates into all areas of the client’s life.
The successful surrogate partner will work to build the same level of intimacy and commitment that exists in regular relationships. This may involve various exercises in touching sexually, sensually and even non-sexually, as well as encouragement and training in social skills, and learning to please a partner and accept intimacy and pleasure unselfconsciously.
Some SP’l‘s claim 85% success in cases of erectile dysfunction, and claim to succeed where conventional therapy and medical intervention have previously failed. Ensure that your potential surrogate has been trained to International Professional Surrogate Association standards and ask lots of questions before committing to an expensive program of treatment. You will also work with a regular sex therapist, and between the three of you, you will decide on boundaries, goals, and the length of your relationship with your surrogate. Yes it’s expensive, but you may consider it money well spent if it solves your problems. However, not every man is a suitable candidate for Surrogate Partner Therapy, so it may be better to talk to a conventional sex therapist before pursuing that treatment option.
While sex therapy is not for everyone, it is a viable option for treating erectile dysfunction, because it concentrates on the sexual aspect of your life while also encompassing your relationships and lifestyle. It can be initially embarrassing to discuss such intimate matters, but you could find the experience both empowering and effective. Cost may be a determining factor, since sex therapy, and particularly surrogate partner therapy, can be expensive, and is not usually covered national health services or regular health insurance policies. However, if other options have failed, you may want to try some form of sex therapy to address your erectile dysfunction issues.