What Actually Happens in Psychosexual Therapy?
A lot of people put off psychosexual therapy for months, sometimes years. Usually it isn't the problem itself that stops them. It's not knowing what they'd be walking into.
Will I have to describe things in detail? Will it be awkward? Is there anything physical? What if my partner won't come?
These are fair questions, and you shouldn't have to book a session to get the answers. So here's what actually happens, from the first email to the last session.
Before your first session
You get in touch by email or through the contact form. You don't need to explain everything at this point. A line or two is enough, such as "we've stopped having sex and don't know why" or "I get erection problems and it's affecting my confidence."
We'll reply to arrange a first appointment, either online or in person. Online sessions work well for a lot of people. You can be at home, and there's no waiting room to sit in.
If your difficulty could have a physical cause, such as pain during sex or erection problems, we may suggest seeing your GP as well. That isn't us passing you on. It's about ruling things out, so we're not working on the wrong problem.
The first few sessions
The early sessions are mostly about understanding what's going on. Your therapist will ask what brought you here, how long it's been happening, and what you've already tried.
They'll also ask about your history. That covers relationships, health, what you learned about sex growing up, and any difficult experiences. Some of these questions can feel personal. You can always say "I'm not ready to talk about that yet", and that's fine. Nothing has to be said in the first session.
By the end of this stage you should have a clearer picture of what's keeping the problem going. You'll also agree on what you want to be different. That's the plan you'll work from.
What a session is actually like
It's talking. You sit in a room, or on a video call, and have a conversation. Sessions last 50 minutes.
Nothing physical happens. You won't be examined, you won't undress, and you will never be asked to do anything sexual in a session. People ask about this more than anything else, so it's worth saying plainly.
You don't need the right words, either. Plenty of people find it hard to say "orgasm" or "erection" out loud at first. Your therapist talks about sex every day and won't be shocked or embarrassed. Most people find the awkwardness wears off within a session or two. Often it goes much faster than they expected.
Between sessions
A lot of the change happens at home. Your therapist may suggest things to try between sessions. These could be reading, noticing patterns, a breathing exercise, or a conversation with your partner that you've been avoiding.
For couples, this often includes sensate focus. It's a set of touching exercises done in private, in stages, with a clear rule at the start: no sex, and no aiming for arousal. Taking that pressure away is the point. Many couples find they can relax and enjoy touch again for the first time in a long while.
You go at your own pace. If an exercise doesn't feel right, you say so and it gets adjusted. If you didn't get round to it, you talk about what got in the way. That's useful too.
On your own or together
You can come on your own or as a couple. Plenty of people come alone. Maybe they're single, or their partner isn't ready, or the issue feels like theirs to work on first. Coming alone doesn't mean you can't make progress.
If you're in a relationship, it often helps to bring your partner in at some point. Sexual problems rarely belong to one person, even when it looks that way. But you can start alone and decide later.
How long it takes
It depends on what you're working on and how long it's been going on. Some things shift in a handful of sessions. Others take longer, especially where there's trauma or a lot of history in the relationship. You'll review how things are going with your therapist along the way, so you're never left wondering whether it's working.
Common worries
"My problem is too embarrassing." Your therapist will almost certainly have heard it before. Low desire, erection problems, pain, porn, not being able to orgasm, never having had sex: these come up every week.
"What if I cry, or freeze, or can't speak?" Then you take a break. Sex is often tangled up with shame or past experiences, and strong feelings are a normal part of the work. Nobody will rush you through it.
"Will it be about trauma?" Only if it's relevant and you want it to be. For some people, past experiences are a big part of the picture. Where that's the case, EMDR can be brought in alongside psychosexual therapy. For others it's about stress, communication or habits, and there's no need to go digging.
"Will my partner be blamed?" No. The aim is to understand what's happening between you, not to decide who's at fault.
Taking the first step
At Sensate Therapy, psychosexual therapy is with Julie Marshall, a psychotherapist and psychosexual therapist. She sees individuals and couples online across the UK and in person in Doncaster. Sessions are 50 minutes: £85 for individuals and £95 for couples.
You can read more on our psychosexual therapy page and see all our fees. If you're ready, get in touch. A short message is all it takes, and you don't have to explain everything yet.
