A day in the life of a sex therapist

“When people talk about their sexual experiences, they are very vulnerable, and I always realize how much effort it takes for them to talk about this topic,” says Amanda Major. A marriage counselor and sex therapist, Amanda has worked with thousands of people in her professional career for over 25 years: singles, married and living together, transgender and gay. Among her clients, the eldest is 83 years old, the youngest is 17.

“They are embarrassed, as if what they are telling is not too shocking, but there is little that I would not have heard about,” says Amanda, “nevertheless, no two stories are exactly the same, that is what makes my work so interesting.” And so successful: 93% of clients who have undergone sex therapy report that their sex life has become more satisfying.

Therapy involves bringing the sexual issue up for discussion, openly but safely. Once the problem is identified, you can start working on it. We often do not admit our sexual difficulties, not only to our partners, but even to ourselves. We hide them, envelop them in mystery and darkness, and therapy helps to open them and bring them to light. As the sex therapist says: “We internalize problems, and sex therapy is about externalizing them, stepping back and asking: what can be done to make it better?”

There are three main areas of therapy: education, improved communication, and fulfillment of tasks given by the sex therapist. Within one day, two or three appointments take place, to which they come both in pairs and singly. The therapy is conducted under the condition of confidentiality, so the names in the examples below have been changed.

They don’t have sex anymore

Anna and Alexander have been together for four years. They are 40 years old. Their daughter is two years old, the birth was difficult, and since then they no longer make love: Anna says she is in pain. Despite this, they would like another child, besides, the lack of intimacy jeopardizes their relationship. They quarrel more often, Alexander is disappointed, and Anna feels guilty because of this.

Today Amanda meets with them for the fifth time. At the first meeting, they discussed their problem and its possible causes: Anna talked about childbirth and her fear of experiencing pain again during intimacy. Alexander admitted that he really wants to make love again and have another child, but stressed that he does not want to upset his wife or hurt her.

“During the first meeting, we always establish what the sexual difficulties are, and I suggest meeting with each one individually to find out more and hear what they would like,” explains Amanda.

She always has three questions. First: what events in the past of each of them affect their current sex life? Second: what unsettles them so much that it becomes a problem? Third: what prevents them from moving on? These questions help in every case, whether it is premature ejaculation, insufficient erection or painful sensations. From the answers to them, which are found together by the specialist and clients, help begins.

Today Alexander, Anna and Amanda are going to set realistically achievable goals. Amanda suggests tasks to do at home, together and apart, to build their self-confidence. The main thing is to avoid stress. When a couple has a sexual problem, some situations increase anxiety: for example, the place where they usually made love can cause anxiety.

The first task for Anna and Alexander is to stop all attempts to enter into physical intimacy. Thus stress is relieved. A little later, Amanda is going to ask Anna how she feels about using dilators—plastic cylinders of varying sizes that fit inside her vagina—to get used to the idea that something might be inside her again. But until the time has come for this, there is still a lot of work ahead: both need help to learn again to be calm, free and sensually attuned to each other.

“I want to help them rediscover themselves and their bodies, to find out what they have become after the birth of a child,” says Amanda. She does not tell her clients about herself because therapy is about them, not about her: “This is not a forum for sharing experiences.” Amanda is wearing an engagement ring so they can guess she is married. She has two adult children.

Sometimes she is asked how this work affects her relationship as a couple. But no one can be a therapist for a husband, family members or friends. Therefore, when sometimes the conversation touches on topics that bother someone from her acquaintances, she responds vividly, but at this time “I am Amanda, not a sex therapist.”

Sex without orgasm

29-year-old Lisa comes to the second appointment that day. She doesn’t have an orgasm. She recently broke up with a friend: this relationship lasted about two years, and the reason for the separation was not her sexual difficulties, but still it seems to her that their sex life would be fuller if it reached a climax.

This is the fourth meeting where Amanda is going to talk about sexual fantasies. She does not ask Lisa to tell her what she imagines: “sex therapy is not about divulging this kind of information, nor is it about any sexual activities during the appointment, but I want Lisa to think about giving free rein to fantasy, because it can help her reach orgasm.”

Talk about your desires

The third and last appointment that day was Viktor and Sophia, they are in their 60s, they have adult children. Their sex life began to freeze: like many men of his age, Victor cannot boast of a stable erection, and Sofia does not feel strong desire. But they understand that if this goes on, then soon they will not have any sex at all, and this upsets them. Amanda intends to educate this couple, because not everyone knows about the possibilities of the human body and its sexuality.

One of the options is Viagra for Victor, however, in one of the previous meetings, Sofia noticed that if he needs to take pills to have sex with her, then she would prefer to do without it at all.

Amanda wants to explain that Viagra is not meant to make someone more desirable, but to improve the body’s ability to respond to sexual desire. She is going to tell how an erection occurs, and show some photos for clarity.

“I’m always very careful with this because some couples don’t want to look at them, but these photos can be very helpful. Many people worry about how their genitals look, and when they see a photo and understand how wide the scope of the concept of “normal” is, they begin to feel much better.

Usually, in couples like Sofia and Victor, the state of the body is rarely discussed, so it’s not so easy to talk about it. But do not rely on telepathy when it comes to such important matters: you will have to talk about your desires, because the partner cannot automatically find out about them.

“I always start a meeting with clients by asking how they completed the tasks they received at the previous appointment. Sometimes they say that they succeeded, and sometimes they say that it was difficult – in which case we discuss what happened and find other, easier ways to complete the task. It’s important to look at it from the client’s point of view: feedback during each appointment helps me plan further.”

It is not easy for clients to talk about their sexual problems, and Amanda always remembers this. In the last few meetings, she gets the feeling that the couple needs privacy again: “they told you a lot in a short time to solve their problem, but now they want to step back, because the sex life is their personal territory.”

Ending therapy does not promise perfect sex for the rest of your life. Therapy helps people decide what is good for themselves. Much in sexual life depends on the ability and desire of partners to find a common language and compromise. A sense of humor also helps.