What Actually Happens In Sex Therapy? We Asked An Expert & Here's What They Said

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Here’s a not-so-fun fact: Some kind of sexual problem will likely touch every long-term couple. It’s just logical. When you have two people with different lives, different desires, and different stressors together for many years, their sexual needs and desires will diverge at some point. And that’s where Pam Costa, sex coach and founder of Down To There, comes in.

“The first thing I always do is normalize the fact that it’s occurring,” Costa tells Bustle. “Basically, it’s almost always occurring. It’s just whether or not it’s distressing to you. If you have two people in a relationship, the chance that you’re both going to want some of anything equally is fairly unlikely. Certainly sex is no exception to that.”

Costa — who has the training to call herself a therapist, but prefers the term “coach” — uses somatic therapy to help clients who have lost their sexual connection or are struggling with another sexual issue. The two main issues she treats? Desire discrepancy (meaning one person wants more sex than the other) and erectile dysfunction.

So what does a sex therapy session typically look like? Costa says it depends on the type of therapist or coach a couple chooses to go to. Some therapists are cognitively focused, asking clients to work through the thoughts in their heads. Some use mindfulness, which is about reconnecting the mind and body. And some use somatic therapy, which encourages people to play with different ways of connecting with the body.

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In Costa’s sessions, she runs “micro experiments” to see how each person’s body works around sexuality. But that doesn’t mean any thing sexual is happening in a session. Couples don’t actually have sexual contact in a sex therapy session. Instead, they focus on the ways that they connect — and the feelings those ways bring up in their bodies.

For example, Costa may have a couple sit face-to-face and just look at each other. She’ll ask them to notice what’s it like to just look. What feelings come up? What fears? What excitement? What’s do they observe in their partner? These questions allow people to not only feel their own desire, but also reveal that they may be making assumptions about their partner that they don’t even realize. It’s a way to open up the avenues of feeling and to also start a discussion between couples that find themselves blocked.

In the case of physical problems, Costa also works with other providers to help her clients overcome their sexual problems. If one person is struggling with erectile dysfunction, for example, and she determines through her assessment that the problem is physical, not psychological, then she’ll refer them out to a doctor to get checked. Or if a woman or other person with a vagina is experiencing pain during penetrative sex, she’ll work with a pelvic health specialist to solve any physical problems that may be causing that pain.

“Clients sometimes put all of their eggs in the sex therapy basket,” Costa says. “But my experience personally and with clients is that the more resources you leverage, the more exploration you do, the richer the outcome.”

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When it comes to finding a sex therapist or coach that’s a good fit, Costa says the first thing people should do is listen to their gut and go with what feels good to them. In terms of qualifications, there’s a wide range that people can look for. Therapists will have gone to school and have a license, but coaches don’t need to have a licensing body. And most masters programs only briefly touch on sex therapy, so even licenses therapists will often have additional training. The wide range in qualifications means that it’s up to each person to decide what’s important to them and find a therapist or coach that meets those requirements.

And for couples who have decided to make the leap into sex therapy, Costa says the most important thing is being open to where each person is making assumptions about their partner. She asks people to drop those assumptions, be open to discovering new parts of themselves, and to be aware of what’s actually going on with their partner.

“If they can enter therapy with that mindset, there’s a lot of possibility for growth for both partners,” Costa says. “I think a lot of people go to sex therapy thinking ‘I just want to have sex that’s not bad.’ But I think for clients who are really willing to put in the work and drop the assumptions, they have the potential to unlock the door to really incredible sex. Sex that is worth wanting.”