Sexual Healing: Why sex therapy doesn’t always work

Last week we talked about sex therapy – what it is and how it works. This week, I would like to speak to those who are already seeking therapy and feeling frustrated with the progress including those who terminated therapy ‘because it wasn’t working’. My hope is that by reading this article, you will gain some insights into what and why therapy is not working and what to do to improve things.

1. You have unclear expectations.

Many times, when clients come in for sex-related therapy, they’re clear on what’s not working in their bodies, lives or relationships. It is part of the therapist’s job to understand where you’re coming from. It is also part of their job to help you clarify what you hope to gain out of therapy. That being said, if after about 3 sessions you still cannot point to the issue, you may end up feeling like you’re talking and working in circles.

What can you do? Answer the following three questions: a) What brought me to therapy? b) What do I hope to get from therapy? c) How will I know that I’ve pinpointed the issue? These are both simple yet complex questions. This is why your therapist is useful to you, because they can help you be able to identify these three things. So, for example, you may have noticed that when things are not good in your life, you tend to isolate yourself from your partner, or your sex drive is significantly affected. One of the ways that you could assess for improvement is in your sex life, and not just whether you are having more sex but also whether you are actually willingly participating in it. In a sense, you are assessing your desire (which is harder to fake to yourself) rather than just the outward manifestation of that desire (which is a lot easier to fake to yourself).

2. You have abdicated your personal responsibility to your therapist.

 As a marriage, family & sex therapist, I can tell you we genuinely and passionately long for and work toward our clients’ well-being. That should be evident in your work with your therapist. However, they are limited by how much personal responsibility you are willing to take over your own progress. If you show up 20 minutes late to your sessions, they are literally limited by the clock. If you come in with erectile dysfunction issues but don’t follow the therapist’s recommendation, you can expect to feel like ‘it’s not working’. If you get a referral to a doctor for further evaluation based on your complaints, and you don’t follow through, there’s not much your therapist can do about it.

What can you do? Own your progress. Engage with your therapist. Don’t just go along to get along. Participate in your own care. If you’re unhappily married, let your therapist know. If a past significant experience comes up through therapy, allow yourself to be vulnerable enough to explore this with your therapist instead of getting defensive about it. Your therapist is committed to you and your well-being and if you don’t believe or feel that, you need to address that with your therapist.

3. You don’t do the work.

 Make no mistake, therapy is work, and many times it’s hard work. It shouldn’t feel excruciating but you’re not going to love every moment of it. There will be information you have to share that you won’t necessarily want to share. There will be homework to do that won’t necessarily feel good or comfortable to do. This is all part of the process that is necessary to get you to get better and improve your life. When your therapist gives you homework and you choose not to do it, you’re sabotaging your own progress. When they ask you questions and you are dishonest with them, you curtail their ability to help you. Therapy is not the place for gamesmanship or ‘sleight of hand’ misdirection. 

What can you do? Simply do the work. If you are given homework, do it. Sometimes it will be as easy as ‘invite your wife to do xyz with you this week’ or ‘can you commit to initiating sex at least once this week?’ Whatever the case, do it. If you forget, say so instead of lying to your therapist. If it was too overwhelming, say so. Do your part.

Remember: this is a voluntary process that is costing you time and money, so make the most of it or you will leave feeling like it just did not work for you when in fact, it was you who did not do the work.

4. You are not honest with your therapist or yourself.

Therapy is a relationship, and it is within that relationship that your healing will take place. This means that the relationship itself must be sound and strong. As we all know, lies are not a good foundation for any kind of relationship, and this holds true in the therapeutic relationship as well. When you say that you’re doing better than you are, you’re only getting in the way of your own healing. When you say that you did something that you didn’t do – or vice versa – you are damaging the very healing that you came for. When you pretend to care about something or someone, the only person you’re fooling is you.

What can you do? Be honest with yourself and your therapist, no matter how scary or uncomfortable it might be. If something isn’t working for you within the therapeutic relationship, let your therapist know. If you feel like you don’t feel heard by them, they’re always late, they dismiss your concerns, you’re not making the progress that you hoped for, be honest about it. If as a result of therapy you realize that your sex drive is connected to resentment you feel towards your partner(s), own up to that with yourself and your therapist so you can spend time working on next steps instead of pretending or hiding it away. In the same breath, be honest about what’s going well. If there have been significant and/or specific improvements, let your therapist know. It’s important for you to experience their UPR (Unconditional Positive Regard) during your losses as well as during your wins. In addition, this information acts as a guide to your therapist on the interventions that are working so that they can use that information in strengthening their treatment plan for you.

5. You’re impatient and/or have unrealistic expectations.

 Sometimes people go for therapy because they think it will offer quick solutions. That can be true in some instances – I’ve had clients come for 1 or 2 sessions and leave, having gotten what they came for. However, more typical is that you may need more time to get the results that you came for. You’ve heard the saying, “a watched phone never rings”? Therapy can be like that sometimes; anxiously hoping for quick results is actually a distraction to the work and to the progress.

What can you do? First, understand that therapy is a process and processes take time. In the same way you cannot take a week’s worth of antibiotics in one day for faster relief, you need to allow the process to take place. It took some time for the problems to manifest to this extent so give therapy some time as well. It would also be good to constantly revisit your goals, hopes and desired outcomes (see #1) so that you have some sort of framework for what you’re working on and what progress you’re hoping for.