What Actually Happens in Sex Therapy?

When most people hear "sex therapy," they assume it's about technique or performance. It's not. Sex therapy is about understanding how your nervous system, past experiences, and attachment patterns show up in intimacy.

For years, I only associated sex with pressure and duty. I sabotaged a relationship I cared about because my body was screaming no, and I had no idea how to restore safety after my own trauma. That experience is why I do this work, and why I never separate trauma from sexual healing.

In this episode of The RISE to Intimacy, I walk you through what actually happens in a sex therapy session, who it's for, and why so many people struggle to stay present during physical intimacy. If you've ever felt disconnected from your body during sex, this episode will show you why healing starts with safety, not performance.

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1:26 – ​​What sex therapy actually looks like behind closed doors

2:57 – Who sex therapy is for and the common issue of desire discrepancy

4:08 – How my childhood trauma led to a career as a sex therapist

5:22 – Why sex therapy and trauma therapy are connected

6:25 – Example of how trauma can quietly reshape desire, safety, and connection

7:41 – Reframe of sex as something that can heal, not harm

Mentioned In What Actually Happens in Sex Therapy? 

Dr. Vicki Van Cleave, PSC

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Full Transcript

 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.

When people find out I’m a sex therapist, I usually get some pretty interesting looks. Most people have no clue what a sex therapist actually does or that it’s even a real job. When sex is talked about publicly, it’s usually about performance, like who’s doing what, how often, and how good it is. But sex therapy is about something much deeper than that.

So today I’m going to answer a few common questions. “What is sex therapy?” “Who is it for?” And “what actually happens in a session?” So sex therapy is a type of talk therapy that helps people explore what’s getting in the way of connection, pleasure, and intimacy. It’s about understanding your body, your emotions, your attachment patterns, and the way you relate to your partner so that sex and emotional closeness start to feel more natural and become more fulfilling and more like you.

In session, we look at things like past trauma, communication struggles, boundaries, or how conflict shows up in your relationship. If you’re like me and you love the nerdy side of things, I weave in neuroscience and somatic work. That means weaving in the brain and the body to help you understand why you react the way you do and how to shift it.

Of course, we do talk about sex. We talk about things like masturbation, porn use, performance anxiety, and how emotional intimacy plays into physical intimacy. But all of that is really just a doorway, a way to help you move closer to what you actually want, like feeling connected or confident and at home in your body again.

To clear something up, sex therapy is not hands-on. There’s absolutely no touching in sessions, ever. Even when I help clients who are struggling to experience orgasm, the work is verbal, emotional, and psychological, but never physical.

Sex therapy isn’t just for people in crisis or those dealing with addiction. It’s really for anyone who wants to feel more present and more connected and more empowered in their sexual and emotional life. Because honestly, sex isn’t just about the physical act. It’s about what it represents to you, like connection or vulnerability, identity, and trust.

So one of the most common things I see in my office is what we call desire discrepancy, when two partners have different levels of sexual desire. It usually sounds like this. One partner says, “I want more sex, but really I want my partner to desire me.” Meanwhile, the other partner is thinking, “I’m exhausted. I can’t even find time for myself, let alone to feel sexy right now.”

So one person feels rejected and the other feels pressured. Then resentment builds, intimacy fades, and both of you end up feeling lonely. But the good news is that dynamic can absolutely change. And it starts with talking about sex from a place of curiosity instead of criticism.

So once people realize I’m a sex therapist, their next question usually is, “Huh. How did you find that?” And “why did you become a sex therapist?” So I actually started out working with trauma and PTSD. I wanted to help others the way my awesome therapist had helped me through my own extensive childhood trauma.

So shout out to Dr. Vicki Van Cleave, who is the absolute GOAT. She helped me make sense of my past. And even more importantly, she helped me let go of shame and humiliation and sadness I’d been carrying for years. And that process truly changed my life.

So thank you, Dr. Vicki. It really helped me finally feel peace. That was something I hadn’t felt in years. And I felt it not just in my mind, but also in my body. So eventually I went on to get my master’s in clinical social work. And I began working at a large group practice.

And then one day a client came in saying they were struggling with sex addiction. And I volunteered to take the case. And I was hooked. It opened up a whole new world for me. I started studying and training. And eventually I realized that sex therapy and trauma therapy aren’t separate. They belong together.

Because trauma-informed sex therapy isn’t just about having better sex. It’s about helping your body relearn that sex can be safe and pleasurable and even healing. So many people who’ve experienced trauma, especially sexual or relational trauma, struggle to be physically intimate. Their bodies associate sex with danger and pressure or loss of control.

That’s why I never push for performance. Instead, I help the body relearn safety and pleasure and unlearn fear. Because the truth is, sex without safety isn’t intimacy. But when safety and emotional connection are restored, sex becomes something entirely different. It can become healing and freeing and deeply authentic.

And that’s the magic of trauma-informed sex therapy. It helps people feel safe enough to fully experience pleasure and connection again. There was a time in my life where I only associated sex with pressure. There was no room for pleasure inside of me.

I remember driving home one night, crying the whole way, because I knew when I got home, my partner at the time would want to be physical. And I literally felt nauseous, even angry, even violated. But he wasn’t doing anything wrong. He just didn’t know how anxious and disconnected I felt, and I had no idea how to tell him.

Eventually, I sabotaged that relationship. And not because I didn’t love him, but because my body was screaming no, because I had no idea how to restore safety after my own trauma. So at that time, sex wasn't only pressure to me, but I also thought of it as a performance and a duty if I was going to do it.

But what I’ve learned since then is that true pleasure can’t exist without being present in your body. Dissociation might protect you for a while, but eventually it builds a wall between you and the person you love, and honestly, between you and yourself.

So through my own process of therapy, I learned that sex can be one of the most grounding and healing experiences when it’s rooted in safety and trust. It’s where I learned to let go of all the roles I play as therapist, mom, business owner, and just be a person who can experience passion and depth and connection.

And that realization changed everything for me and for how I decided to work with my clients. So when I say I’m a trauma-informed sex therapist, I mean that I understand how pain and betrayal don’t just live in your memories. They live in your body.

They shape how you breathe, how you react, how you trust, and how you show up in intimacy. So instead of asking, “What’s wrong with you?” I ask, “What happened to you?” Or more importantly, “How did your body learn to protect you?”

It’s about safety first because healing can’t happen in a space that feels unsafe. So before we talk about pleasure or desire or sexual connection, we have to build that foundation.

And if this episode resonates with you and you’d like to explore how sex therapy might help, visit risetointimacy.com and click the Free Consult button to schedule a complimentary session with me. In episode three, we’re going to talk about a framework I use to help couples repair after conflict or betrayal and rebuild emotional safety.

Thanks so much for listening. And remember, sex therapy isn’t for people who are broken. It’s for people who are brave enough to look beneath the surface.

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.

I’m so grateful for all your support. You can learn more about my coaching packages for individuals and couples at risetointimacy.com. Remember, sex therapy isn’t for people who are broken. It’s for people brave enough to look beneath the surface.