Sex Therapy and Couples Therapy Shouldn’t Be Separate
Couples can spend months or even years working on communication, conflict, and trust without ever talking about what is happening in their sex life. Once sexual concerns come up, their couples therapist may refer them to a sex therapist, almost as if sex is a separate problem that needs to be handed off to someone else.
Part of the reason is that many couples therapists were never formally trained to talk about sex. That can leave couples doing important work on their emotional connection while their physical connection remains completely outside the conversation, even though the two are often affecting each other.
In this episode of The RISE to Intimacy Podcast, I explain why sex therapy and couples therapy are often treated as two separate specialties and why I do not think that reflects how relationships actually work. I also clear up some common myths about what each type of therapy looks like in a session and why couples should not have to choose between addressing their emotional connection and their sex life.
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1:59 – How traditional couples therapy differs from sex therapy
3:07 – The training gap most couples therapists face, and the road to sex therapy qualification that I had to travel
4:54 – Why these therapies shouldn’t be considered completely separate from each other
7:42 – Debunking four common myths about sex therapy and couples therapy
9:14 – The one thing you should take away from this episode
Mentioned In Sex Therapy and Couples Therapy Shouldn’t Be Separate
Full Transcript
Valerie McDonnell: Welcome to The RISE To Intimacy Podcast. I'm your host, Valerie McDonnell. And for over a decade, I've worked as a sex and couples therapist, because intimacy used to feel really overwhelming for me. I felt a lot of pressure to perform, I was disconnected from my body and I often felt like desire was out of reach for me. But through my own trauma work, I stopped checking out of my body and started feeling connected to it again. I learned what it's like to experience intimacy without fear, without shutting down and without numbing out. Now I'm on a mission to help you do the same thing. This podcast exists because trauma doesn't get the last word. You can learn how to calm your body, change the story you've been carrying and rebuild real connection, first with yourself and then with the people you love.
Let's begin. Somewhere along the way, we bought into the idea that if someone has a specialty, that's all they're capable of treating. I've experienced multiple occasions where a couple will start working with me and mention they're also seeing a couples therapist, or that their couples therapist referred them to me for the sex stuff. But I don't know how sex therapy could actually work without also addressing a couple's communication and emotional connection. It's incredibly hard to improve your sex life while resentment, trust issues, or mismatched attachment styles are still running the show. And I don't know how couples therapy could really work either, without ever tending to a couple's physical connection. The way I see it, sex and couples therapy were never meant to be two separate things. They're both talking about the same relationship, just from two different angles. So today I'm going to talk about the differences between sex and couples therapy, tell you what I think the field of couples therapy is missing and bust a few myths about what sex therapy and couples therapy actually look like in a session.
So let's start with the differences between these two. Traditional couples therapy tends to focus on things like communication patterns, conflict resolution, trust repair and general emotional connection. You're typically working on your patterns of conflict, how you repair after a disagreement and things like how you feel seen and supported by your partner. Sex therapy, on the other hand, focuses specifically on sexual function, desire, arousal and intimacy. These are things like mismatched libido, difficulty with orgasm, performance anxiety, or navigating a specific sexual concern. In the majority of situations, these are treated as two completely separate specialties. Sometimes couples are actively seeing two different therapists, where a couple's therapist will refer out to a sex therapist, once sexual issues come up. Almost like sex is a specialty problem that needs to be handed off to someone else.
But that separation doesn't reflect how relationships work in real life. There's a study that surveyed clinical members of the American Association for Marriage and Family Therapy and it found that a huge number of therapists reported feeling uncomfortable even addressing sex with their clients. And it wasn't because they thought it didn't matter. It was because they were never trained to talk about it. Comfort with these conversations was directly tied to whether a therapist has specific education in human sexuality and also receives supervision from an experienced clinician in the field. Without that training, most therapists just avoid the topic altogether. In my master's program, I was trained in a wide range of mental health theories, diagnoses, and treatments. At first, I thought I wanted to specialize in trauma and PTSD, so I even chose electives that focused on those areas. Before I could even graduate, I had to complete 900 hours of clinical internships. Then after earning my master's degree, I completed another 3,000 supervised clinical hours, working with clients, before passing my licensing exam, to become a licensed psychotherapist. And even after all of that training, I still hadn't received any formal education in sex therapy.
So when I realized I wanted to specialize in helping couples with intimacy and sexual concerns, I had to seek out an additional two year sex therapy training program. So all of that is to say that you can spend months, or even years working on your communication and trust issues in couples therapy without your sexual connection ever coming up. Because your therapist never gained the skills and knowledge to comfortably open the door to those conversations. Many people who come to me, aren't looking just for couples therapy. They're looking for help with feeling disconnected in their sex life, or mismatched desire, or something like erectile dysfunction that started to feel like it's affecting the whole relationship, not just your sex life. But to adequately address sexual concerns, we also end up doing the exact work most people associate with couples therapy. We talk about communication. We talk about how you and your partner repair after conflict. And we look at past trauma, attachment styles and whether trust and respect show up consistently in the relationship.
And this is not because I'm trying to expand the scope of what you came in for, but because you genuinely cannot improve a sex life that's struggling, without addressing the relationship patterns contributing to it. So while many people know me as a sex therapist, I rarely separate sex from the relationship itself. If I only focused on the sexual concerns you walk in with and never tackled things like communication, trust, or emotional connection, I'd just be treating a symptom and missing what's actually driving it. And to back this up with some research, a study that analyzed client feedback from a major clinical trial of couples therapy, found that clients consistently said they wanted more discussion of sexual issues during their sessions. Couples aren't looking for their sex life to be treated as a separate optional topic. They're actively asking for it to be part of the work and a lot of therapy isn't providing that. And I don't think that gap should exist. You can't fully repair a couple's emotional connection without addressing what's happening physically. And you can't fully repair what's happening physically without addressing what's going on emotionally, because one almost always affects the other.
A lot of people picture sex therapy as either a place to talk logistics, tips, or how to spice things up and they picture couples therapy as mostly about communication exercises. In reality, it's hard to talk about one without naturally talking about the other. We might start talking about a recent argument, work through what happened, how you each felt and whether you were able to repair afterward. And in that same session, we might also end up talking about how that argument has led to a feeling of disconnection in your sex life too, because usually it has. Again, emotional distance and sexual distance usually aren't two separate problems. The same disconnection shows up in how you talk to each other and in how you touch each other. So now let me clear up some of the common myths I hear about both sex therapy and couples therapy.
Myth number one, sex therapy means something in your relationship is already damaged beyond repair. And this is not true at all. A lot of my sex therapy clients tell me they're attracted to their partner and they're still very much in love, but desire isn't showing up consistently anymore. These are couples who aren't trying to save their relationship. They're trying to make a good relationship feel deeply connected again.
Myth number two is that sex therapy means I'm going to jump straight into asking invasive, uncomfortable questions. And that is also not true. We build trust and rapport first, exactly the same way we would in any other kind of therapy. Nobody should be diving into the deep end in the first session.
Myth number three is that couples therapy and sex therapy are for two completely different kinds of problems. And again, in my experience, it's almost always the same root issue, just labeled differently, depending on where it shows up.
And myth number four is if you're already seeing a couples therapist, your sex life is automatically part of the conversation. Unfortunately, as I've said, this is usually not the case, which going back to the research I mentioned earlier, is exactly the gap a lot of therapists were never trained to close.
So the one thing I hope you take away from today's episode is this. Your emotional relationship and your sexual relationship were never meant to be treated as two separate parts of your life together. The way you communicate, repair and build trust, shapes what happens between you physically. And what happens physically influences how emotionally connected you feel too. They're not meant to be two separate conversations. That's why I don't believe couples should have to choose between couples therapy and sex therapy. When we treat the relationship as a whole, we give every part of it the opportunity to heal and grow together.
Thank you so much for listening. I truly appreciate your support and I would love it if you left me a review on your favorite podcast platform. If you'd like to work with me, head over to risetointimacy.com and book a consultation. And there you can also sign up for my free weekly newsletter, the quickie, where I offer tips and tricks to help you create a healthier, more connected relationship. See you next week.
Thanks for listening to The RISE To Intimacy Podcast. If today's episode resonated with you, know that healing is possible and you don't have to do it alone. If you're enjoying the show, please leave a rating and review for us at ratethispodcast.com/rise. It really helps others find us and I'm so grateful for all your support. You can learn more about my coaching packages for individuals and couples at risetointimacy.com. And remember, sex therapy isn't for people who are broken, it's for people brave enough to look beneath the surface.
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