A Day in the Life of a Sex Therapist

7.30 a.m. – Monday morning, a cup of coffee waits for me on the bedside table (one sugar, no milk, in case you are wondering)… Snippets of thoughts are still with me from the night before when I was talking to a Humanistic Psychology Practitioner. “You are a sex therapist? We don’t really need any, we all deal with sex all the time,”she said.

Sigh, yes. That would have been the same colleague who, when recently leaving hospital, referred to her problems as “down below,”as invariably many nurses, including specialist ones, do. Are we talking knees, toes, or heaven knows what else “down below” might refer to? And is “down below” a new diagnostic term? How does my colleague square that degree of non- specificity with claiming that she and her colleagues talk about sex “all the time”?

Having been a sex therapist (and couples therapist, and psychotherapist) for several decades now, I do not cease to be amazed at the way people talk about sex. The spectrum is wide: for many, in this culture, it is still referred to as “intimacy” (really ? is sex always ‘intimate’ ?), as “needing fixing”, as if we were some kind of electronic device, and then always obscurely featuring, ever so slightly, some hetero-normative notion that, at some point, some woman, some man, are attracted to each other, romantically speaking, or fancy each other (sexually speaking), will make babies at some stage (do they all ?) and remain together, lovingly gazing into each other’s eyes, until “death do us part”.

The reality, of course, is different, as relationship statistics in the UK confirm (for example 42 per cent of marriages now end in divorce and the average lifespan of relationships is 11 years, shorter than our relationship with our current account providers!

Not all clients asking for sex therapy are coupled. Some are individuals with a thriving sex life, auto-erotic or otherwise. Not all are couples in a monogamous sense. And most couples I see, in London, are neither white, nor young, nor virile, fertile, heterosexual or even “British”. My first client this morning (2 cups of coffee later) is a case in point:

Rafik, 27, a shy single man has flown in from Dubai since “sex therapy” does not exist in his country. He is largely silent in the session, relying on me on asking specific questions – very few, I hasten to add, require me to ask about stuff “down below”. He has no wife. It transpires that this covers a wider landscape than living on his own, since sex, for a devoted Muslim, including sex with himself is not an option. He likes women he says. I enquire further, taking an inspired guess:”and men also?” He nods, gravely. I am wondering whether he knows about lifestyle choices, or sexual orientation … and he says he understands most of it. I fumble my way through the session unclear what the presenting issue might be and how I might help Rafik. Fifty minutes into the session I am no clearer (and I am the expert!) and Rafik declares, as he gets up to leave : “thank you for your help. I know now what I must do. I shall be like my uncle..!” The rest remains unsaid and yet, between us men, then, ultimately understood.

Later that day, a stunningly attractive youngish Irish-English couple, heterosexual, married for 4 years and without much happening on the sexual front. “We never do it” she says. “It’s not that bad” mutters he and, when I asked him whether he masturbates, nearly falls off his chair. Uncertain whether I used the wrong terminology I re-iterate my question…”you do wank?” and he blanches visibly. He says, indignantly “how dare you ask me that question in front of my wife!” and I wonder what he thought might happen in sex therapy without asking oneself these questions. She asks him, gently: “do you never touch yourself?” and he, now, responds, slightly more composed, in the negative. “I do it twice a day” she pipes up and states that she’d happily do it twice with him too. Several sessions later I see the picture more fully: she wants a child, he doesn’t since he feels that he would be a poor dad. His own father had left the family when my client was in his infancy. Sexually speaking, they were fine. They were just conflicted somewhere else.

My third therapy slot that day: A straight couple, three kids, she requests therapy since “my husband is polyamorous” and they want, she says, to negotiate terms. She has never spoken to anyone about their sex life and in her culture it is customary that she does not spend time on her own with a male – including a male therapist. Would she perhaps rather see a female colleague or someone from her own community? That would be impossible she states. We manage somehow since her husband attends therapy with her, “otherwise”, she suggested “we could always leave the door to the therapy room ajar”. Not something I had learnt in my own therapy training!

Finally, Jerome, 42, presents with “impotence”. When asked whether he had tried therapy before he fesses up that he’d been with a Jungian for eight years, but they never talked about “this”. When asked why not he states “how? she is a lady therapist!” The confusion that runs through my day continues. You see, Jerome is not and has never been ‘impotent”. He functions perfectly well on his own. He would, more correctly, have been diagnosed with situational erectile problems, fairly easy, therapeutically, to deal with and clearly related to his relationships with women rather than that with his knob.

Identities and cases have been disguised and are fictitious based on case material. If you are interested in training as a sex and relationship therapist, talk to us at www.psychosexualtraining.org.uk.

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