Behind the Curtains: What Happens in Sex Therapy?

Sex therapy can seem like a mysterious process, especially for those who have never been. The idea of discussing something as intimate and personal as sex with a stranger can raise a lot of questions: What does a sex therapy session really look like? What happens in a session? Will I be judged?

As a therapist specializing in sex and sexuality, I can tell you, all of these questions are normal. There are many misconceptions about sex therapy and what happens in a session, so let’s dive in.

Setting the Stage: The Foundation of Trust

The very first thing you should know about a sex therapy session is that it’s all about creating a safe, welcoming space. From the first phone consultation, to when you walk into my Washington, DC office, the focus is on creating an environment where you can speak openly about sex and your sexuality.

We’ll start by discussing your concerns in detail—anything from anxiety about sex, body image issues, or challenges in your relationship, to questions about sexual orientation or desires you’d like to explore. There is no need to feel embarrassed or awkward (though you might anyways, and this is totally normal!); this is a space where your identity and experiences are respected and validated.

What’s on the Table? Issues We Can Address in Sex Therapy

Sex therapy covers a broad spectrum of issues related to sex and sexuality. You might come to therapy because of specific challenges like:

• Anxiety or stress about sex

• Body image and self-esteem concerns

• Embarrassment about what your desires include

• Misaligned sexual desires or expectations with your partner

• Low libido or lack of sexual desire

• Sexual trauma or abuse recovery

• Exploring kink, fetishes, or non-monogamous relationships

• Sexual orientation or gender identity exploration

• Sexual dysfunctions such as erectile dysfunction or painful intercourse

• Increasing your sexual pleasure and enjoyment

Whether your concerns are physical, emotional, or relational, we’ll work together to address what’s holding you back from enjoying a more fulfilling sex life.

The Therapy Process: How We Work Together

Once we identify the issues you want to focus on, we’ll dive into understanding the underlying emotional, psychological, and relational factors contributing to these challenges. I approach therapy with a psychoanalytic lens, helping you uncover any unconscious beliefs or past experiences that might be affecting your current sexual health and identity.

Here’s a breakdown of the process:

1. Exploration

We’ll begin by talking about your sexual history, relationships, and any past traumas or experiences that may have shaped your current situation. I’ll guide you in exploring your sexual identity, desires, and how you connect with your partner(s). This is your opportunity to reflect on who you are as a sexual being, free from judgment or pressure to conform to societal norms.

2. Addressing Issues

After we identify the root causes of your concerns, we’ll focus on developing strategies to help you manage them. This might involve techniques to address negative messages you have formed about sex, behavioral exercises to improve intimacy, or communication strategies to help you express your needs more effectively. We might focus on reflecting on your relationship to your physical body to reconnect with your body’s ability to experience pleasure and learn to do this without the pressure of performance.

3. Healing and Growth

Sex therapy is not just about solving problems; it’s about healing, learning, and growing. As we work through your concerns, you’ll begin to reconnect with your sexual self and rebuild your confidence. We’ll explore what brings you joy, pleasure, and satisfaction—whether that’s through solo experiences or in connection with your partner(s). Along the way you will learn about the ways that your views of sexuality have been implicitly shaped by messages from society.

4. Ongoing Support

Much like any therapeutic journey, progress takes time. Our sessions are tailored to you and your specific needs. My goal is to help you feel more in control of and fulfilled in your sex life. Through guidance and support, my hope is that you find change that enhances your overall well-being.

What Doesn’t Happen in Sex Therapy

There are many misconceptions about sex therapy, so it’s important to clarify what doesn’t happen during sessions. No sexual activity takes place. Therapy does not involve engaging in any sexual activity with your therapist. The focus is entirely on discussion, exploration, and healing. 

Additionally, there’s no judgment or shaming. Whether you’re exploring your sexuality, dealing with past trauma, or seeking ways to enhance intimacy, a sex therapist will help you feel heard and supported, not judged or criticized.

Why Consider Sex Therapy?

You may wonder, "Is sex therapy right for me?" or, “When should I begin sex therapy?” 

You don’t need to have a major sexual problem to benefit from therapy. Many people turn to sex therapy to gain a deeper understanding of themselves, rekindle intimacy in their relationship, or heal from past trauma. It’s about embracing who you are—sexually and emotionally—and gaining the tools to live a more connected and fulfilling life.

Sex therapy provides a unique opportunity to get to know your body, your desires, and your identity in a safe, accepting space. By addressing the issues that are limiting your sexual health, you can experience more connection, confidence, and joy in your relationships with others—and with yourself.

Looking for Sex Therapy in Washington, DC?

If you’re ready to begin your journey toward self-discovery and sexual empowerment, I encourage you to reach out. Whether you’re struggling with sexual difficulties, seeking to explore your identity, or wanting to improve your intimacy and connection with your partner, I’d be honored to guide you toward the positive change you’re seeking. Contact me for a free consultation or book an appointment to get started.

Dr. Wayne Bullock is a compassionate, experienced, and licensed counselor in Washington, DC focused on the needs of gay men and the LGBTQ community. Specialties include the treatment of trauma, depression, anxiety, and sex therapy.