Is Couples Therapy Different Than Sex Therapy?
Is couples therapy different than Sex Therapy? The short answer is… it depends! Sex therapy is very rarely only focused on sex-related topics, because sex is so much more than just a physical act. Parenting, life transitions, anxiety, grief, hormonal shifts, old hurts and underlying attachment wounds and more can all impact people’s sex lives, desire and intimacy.
Often, when couples come to see me for sex therapy, I start by asking similar questions to what I would ask in a couples therapy intake session, covering things like their history with counselling, self-care, cultural identities, family and friend dynamics, their story as a couple, old wounds, mental health history, and what comfort and emotional care looked like growing up. In addition to these questions, I go through an integrated sexual history with each person that looks at beliefs, education, personal experiences and expectations around sex and intimacy.
How is Sex Therapy Different Than Couples Therapy?
The biggest differences have to do with client goals. If a couple comes to me with the goal of addressing erectile dysfunction, painful sex, desire discrepancy, differences in fantasies or kinks, or exploring new forms of sexual intimacy, our work will centre on the things that underlie those issues. Typically the presenting issue is a symptom of something else that has yet to be explicitly explored.
Sometimes one partner’s goal is increasing intimacy, while the other’s goal is to attend to non-sexual needs they feel are not being met. When this occurs, we all work together to come to an agreement on overall goals that encompass both people’s needs.
Sex therapy also creates space for clients to voice sexual concerns, traumas, desires, fantasies or kinks, to reduce shame, increase agency, and increase a partner’s capacity to affirm these parts of their partner. It is not an expectation that clients share these things, but should they want to, there will be no judgement from my direction.
Emotional and physical safety is paramount for a good sex life, and sex therapy is about building that safety. It might also involve homework, such as exploring non-sexual touch, slowing down intimacy, talking about fantasies, or writing down beliefs around sex and where they came from.
In couples therapy where sex and intimacy are not primary goals, we focus on things like reducing resentment and contempt, understanding each other’s perspective, learning how to communicate needs, and more. Often resentment and contempt can impact desire and intimacy, so this can also come up in sex therapy. In both modalities, I work from a relational lens, helping each partner be more explicit with their needs while making space for their partner’s needs as well.
So, in short, sex therapy can look very much like couples therapy, because it’s a form of couples therapy. You could think of it as improving sex and intimacy being the overall goal.
If you have been wondering whether sex therapy might be a good fit for you, I offer 15 minute consultations to all new clients. I provide sex-positive, queer-affirming, gender-affirming, and kink-affirming therapy to individuals and couples, and to those who practice non-monogamy.
