What to Expect When You See a Sex Therapist | Jen Joseph, LMFT, CST | AASECT Certified Sex Therapist
If you've been thinking about seeing a sex therapist but keep putting it off — because it feels awkward, or you're not sure what actually happens in those sessions, or you're worried about being judged — this article is for you.
First: What Sex Therapy Is Not
Sex therapy does not involve any physical touch, nudity, or sexual contact of any kind. Everything happens through conversation — just like any other form of psychotherapy. If you've ever wondered or worried about this, you're not alone, and I want to put it to rest right away.
Sex therapy is also not a place where you'll be told what's "normal" or made to feel judged for what you want, what you've done, or what you're struggling with. An experienced sex therapist has heard it all — and I mean that. Whatever you're navigating isn’t going to shock or offend me.
Who Sees a Sex Therapist?
More people than you'd think — and for a much wider range of reasons than most people assume. Some of the most common issues I work with:
Individuals:
Low or absent sexual desire
Sexual pain (vaginismus, vulvodynia, dyspareunia)
Performance anxiety around erections or arousal
Out-of-control sexual behavior, aka sex and porn “addiction”
Questions about sexual identity, orientation, or interests
Shame or discomfort around sex or your own body
Sexual trauma and its impact on intimacy
Sexual aversion
Couples:
Mismatched libidos or desire discrepancies
Sexless or near-sexless relationships
Difficulty talking about sex with each other
Repairing from infidelity/ betrayal and rebuilding sexual trust
Opening a relationship and creating agreements that work
Sex that has become routine, disconnected, or unsatisfying
One or both partners avoiding sex without fully understanding why
If any of these sound familiar, individual or couples sex therapy is probably worth exploring.
What Happens in the First Session
The first session is a chance for me to understand what brought you in, what you're struggling with, and what you're hoping to get out of our work together. I'll ask questions about your current concerns and their history, what you’ve already tried and anything I think would be pertinent to understanding the root of the issue(s) you’re coming in for help with. The questions will feel personal– because they are. However, you can always tell me to slow down or we can visit the question at a later point.
The questions are meant to help me build a picture of who you are and what you need, so that the work we do together is targeted to precisely where you need support. I don’t offer cookie-cutter therapy or generic sex or relationship advice. While I know there can be common patterns to what I see with my clients, each person and relationship is unique and I want to make sure I understand you (and your relationship) clearly and specifically.
“Assessment” is an ongoing, unfolding process that deepens through my experience of working with you. What I understand about what’s driving your struggles by session ten is going to be greater than my understanding at session three. However, by the end of the first few sessions, we’ll have a clearer sense of what we’re working on and a rough roadmap for how to approach it.
What the Ongoing Work Looks Like
Sex therapy is talk therapy. Sessions involve conversation — exploring feelings, patterns, history, and the dynamics at play in your relationship or within yourself. Depending on what you're working on, I might also suggest exercises or practices to try between sessions. These are always discussed and agreed upon together; nothing is assigned without your understanding and willingness to participate.
In my practice specifically, the work is present-focused and experiential — which means I'm not just interested in understanding your history, I'm paying attention to what's happening in the room right now. If you're a couple, I'll have you talk directly to each other so I can see where you get stuck and what gets in the way of closeness. If you're an individual, I'll be curious about what's happening in your body and emotional experience as we talk (as this is often connected to present-day concerns) , not just the content of what you share.
I'm direct. I'll ask questions that many therapists avoid. And with your permission, I’ll point out my observations of what I see as getting in the way of your stated goals.
A Note on Shame
Most people who come to sex therapy are carrying some degree of shame — about their desire level, their sexual history, their body, what they want, what they've done, or what they haven't been able to do. That shame is often what's kept them from seeking help sooner.
Shame is, unfortunately, very common but luckily, entirely treatable. You don't have to have it resolved before you come in. You just have to be willing to show up and talk honestly. The rest we figure out together.
What Sex Therapy Can and Can't Do
Sex therapy is highly effective for a wide range of sexual concerns. But it works best when both partners (if you're coming as a couple) are genuinely willing to engage — not just showing up to support the other person, but doing their own honest work in the sessions.
It's also worth knowing that some sexual issues have medical components. Sexual pain, hormonal changes, erectile difficulties, and arousal issues can all be influenced by physical factors — and if that seems relevant to your situation, I may recommend a medical evaluation alongside our work together. Sex therapy and medical treatment aren't mutually exclusive; often the most effective approach combines both.
What sex therapy (or any good psychotherapy, for that matter) can't do is produce change without your engagement. Therapy isn't a passive process. You'll be asked to reflect, try things, and sometimes sit with discomfort. That's where the growth happens.
How Long Does It Take?
That depends entirely on what you're working on. Some issues — like a specific communication block or a well-defined concern — can shift meaningfully in a month or two. Others, like rebuilding sexual trust after infidelity or working through the impact of sexual trauma, take longer. I'll give you my honest assessment of what I think the work requires, and we'll check in regularly on how things are progressing.
What I can tell you is that I don't believe in indefinite, open-ended therapy that keeps you coming back without moving forward. My goal is to help you make real change as efficiently as possible.
How to Find the Right Sex Therapist
Not all therapists who say they work with sexual issues have specialized training. AASECT certification — through the American Association of Sexuality Educators, Counselors and Therapists — is the gold standard credential in the field. It requires extensive supervised clinical hours specifically in sex therapy, and it means your therapist has been rigorously trained to work with the full range of sexual concerns, not just the ones that come up incidentally in general therapy.
I'm one of a small number of AASECT Certified Sex Therapists in California and Oregon. If you're looking for a sex therapist anywhere in the world, the AASECT directory is a good place to start.
Beyond credentials, trust your gut. The right therapist is someone you feel you can be honest with — even about the things that feel hardest to say out loud. If you don't feel that after the first few sessions, it's entirely okay to keep looking.
Ready to Take the Next Step?
If you're in California or Oregon — including the San Francisco Bay Area, Oakland, Los Angeles, or Portland — and want to explore whether sex therapy might be right for you, I offer a free 15-minute phone consultation. There's no pressure and no commitment — just a low-stakes chance to ask questions and see if we might be a good fit.
You might also find these helpful:Why Couples Stop Having Sex — and What to Do About ItMismatched Libidos: A Guide for the Lower Desire Partner
Jen Joseph, MA, LMFT, CST is an AASECT Certified Sex Therapist, licensed psychotherapist, experienced couples therapist and Certified Discernment Counselor. She specializes in sex therapy, infidelity recovery, discernment counseling and relationship therapy, practicing online with individuals and couples throughout California and Oregon including San Francisco, Los Angeles, San Diego, San Jose and Portland, Oregon.