Many sex therapists believe there’s no such thing. But what they do agree on is that psychosexual therapy can help most couples find their way back to a more connected and satisfying relationship with their partners
‘We need to get rid of the idea that sex is either “good” or “bad”,’ says psychosexual and relationship therapist Karen Aram, who has run her private practice in London for 10 years (karenaramtherapy .co.uk). ‘Otherwise we enter into this awful inner civil war of “I have to be really turned on, it’s got to be good”, as though there’s some kind of metric for what “good” means – there isn’t. Part of our role as sex therapists is to remove this unhelpful binary by looking at how any of our ideas about sex come to be the way they are.’
Often with roots of CBT (cognitive behavioural therapy), psychosexual therapy encourages us to explore how our thoughts are formed when it comes to sex, before slowly working to change our preconceived ideas. ‘We think our feelings and we feel our thoughts,’ Aram says. ‘People often ask me what I mean by that, and I’m talking about our mind-body connection. If we’re thinking about what’s for dinner during sex, for example, we’ll never tune in to our bodies – our thoughts have taken over our feelings.’
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Issues and worries around sex are more common than you might think, and psychosexual therapy can be helpful to everyone. ‘You don’t have to be at crisis point,’ says Kate Moyle, psychosexual therapist and host of The Sexual Wellness Sessions podcast. ‘A lot of people feel they need to have a serious problem, but if you’re struggling with any aspect of sex, psychosexual therapy can be a good place to address that.’
So, are there things we can all learn? We asked three leading therapists to identify and explain the most common issues their clients face – and share how to navigate them.
Performance anxiety
In modern society, comparison culture is everywhere and for many of us, this leads to worries about sexual performance, says Kate Moyle. ‘The sex we see through porn, films or on TV is not necessarily like the sex that we’re actually having in real life – it’s specifically designed to look good on camera.’ She adds that performance anxiety develops due to an inherent but unrealistic perfectionism: ‘Sex is one of the only areas of our lives where we form an idea that everyone should just know what they’re doing, but we rarely ask questions or open conversations about how to know what we’re doing.’
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Often, clients will come to the therapist space expressing this very problem. ‘These people are in the room because what they’re doing has not been working for them,’ says Dr Amani Zarroug, a clinical psychologist and psychosexual and relationship therapist. ‘I want to find out if they’re tied to an idea that sex has to be a specific way. I then challenge that by pointing out that as soon as they start to “perform”, they’re doing what we call “spectatoring” – almost existing outside of their own body watching, so they’re no longer connected to their own pleasure.’
A really good exercise, experts agree, is myth busting. ‘By writing down our sexual beliefs on paper and asking, “Where did I learn that from?”, we can start to call into question certain ideas that we have, and think about where they come from,’ says Moyle. ‘Much of the time we’ve never really thought about where our core beliefs around pleasure stem from until it’s a problem, so actually questioning them is an important exercise.’
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Discrepancy in desire
For Aram, who works predominantly with couples, desire discrepancy between partners – or different libido needs – is very common. ‘When people come to me, I will always start by looking at the backstory,’ she says. ‘I’ll call into question: Was it always like this, or has there been an
emotional event that has triggered one partner to lose their drive?’
Issues around libido are particularly common when couples are trying to conceive, particularly during IVF, or struggling with infertility. ‘However, it could also be that one partner has just never had a high sex drive, in which case it’s about understanding that the person with the lower drive controls the amount of sex within a relationship.’
Moyle says that, in this case, the person with the lower sex drive is often left with little opportunity to really understand when they want sex, given that the other person wants it all the time. ‘Couples can then get stuck in a cycle of blame and consequently pull away from everything that might lead to sex. This can be particularly problematic because the issue then just gets bigger.’
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Another factor that therapists will look at is the longevity of the relationship. ‘Spontaneous desire is over-represented in films and TV,’ explains Moyle, ‘when the reality is that lots of people, particularly in long-term relationships, have a more responsive desire style. This means that instead of the desire happening in anticipation of a sexual experience, it’s often triggered by the start of the sexual experience – we start kissing and hugging, and then we start to feel turned on. Often, people in long-term relationships think they’ve lost all their desire when, in fact, they’re just more responsive in this way.’
To this end, Moyle suggests carving out more time for intimacy. ‘As therapists, we don’t like the idea of scheduling sex, but we do recommend scheduling time to be physically intimate. We put time aside for planning holidays and calling friends, so we need to apply that same rule to our relationships.’
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Avoidance and distance
All couples, Aram says, have an ‘emotional sweet spot’ when it comes to how intimate or distant they can cope with being. ‘It’s a fundamental human fear that we will be left or abandoned,’ she explains, ‘so when some couples become too far apart, they can feel inherently anxious and naturally start to withdraw and defend.’ This often results in the other person feeling even more frozen out, and can manifest in them withdrawing touch and appreciative comments or compliments. ‘They can then resort to safety behaviours, such as one deliberately going to bed early without the other,’ she explains, ‘until eventually there’s no sweetness left.’
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The approach to rebuilding a major rupture in a relationship needs to be taken very slowly. ‘In therapy, I will often suggest starting safely with reconnection – whether that’s the couple staying in the same room together after dinner, or hugging and looking into each other’s eyes for three to five minutes. We’re not looking specifically at arousal at this stage, but meeting discomfort in a safe environment.’
Dr Zarroug agrees with this gradual approach, citing a technique called ‘sensate focus’, aimed to improve intimacy, confidence and communication between partners, and shifting away from ingrained, goal-oriented sexual patterns that may not be serving the couple. ‘Sensate focus is the gold-standard method for treating psychosexual issues,’ she says. As part of it, couples must agree to a sex ban for the duration of the programme as they gradually reacquaint themselves with their bodies. ‘In knowing it’s not going to lead to sex, the programme removes pressure, so that couples can start to break whatever negative association they had before.’
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Eventually, the exercises become sexual, but initially it’s more about connecting with the sensual nature of your body and what it can offer you in terms of pleasure.
Body confidence
How we feel in our own bodies can have a big impact on our sex lives. However, very often, worries about body image come down to past experiences and psychoeducation, explains Dr Zarroug, such as ‘women worrying that their vulvas don’t look like those in porn films.’ Normalising and understanding that not everyone loves every single thing about their body is a process, she says. ‘I often do an exercise where I ask the person to name three parts of themselves that they like. I might then ask them to stand naked in front of a mirror at home, and talk to that part of themselves. The negative things we’ve been told about our bodies tend to weigh much more heavily than all the positive things we’ve heard, so focusing on the bits you do like often provides an emotional release.’
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From there, Dr Zarroug says, she’ll hone in on a client’s perception of body image when it’s in the specific context of sex. ‘I ask, “when are you most self-conscious? Is it when you’re in a particular position? Is it when there’s lots ‘Couples can get stuck in a cycle of blame and consequently pull away from everything that might lead to sex’ of light in the room?” In shedding light on those moments, we can start to focus on the areas they like more.’
‘Learning what feels good for us is a big part of improving body confidence in sex,’ adds Moyle. ‘So I ask: “What are your good conditions for sex?” It might be that having sex with the light off feels comfortable for you because you’re able to really relax and tune in to what’s happening, or that mindfulness exercises help you to connect with your body more.’
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Struggles with orgasm
‘Difficulties orgasming are very common in women and it’s something I see people worry about a lot,’ says Aram. ‘But orgasm can only happen when there is a certain point of tension and relaxation, like opposing forces. We have to be aroused, but we also have to be relaxed and allow the body to take over.’
‘I start by getting people to write a pleasure journal,’ says Moyle. ‘They note down five things in their day that give them pleasure, whether it’s putting on a really soft jumper, walking outside feeling the sun on their face, getting into bed with clean sheets, the first sip of coffee in the morning or a smile from a stranger. We’re not very good at noticing small moments of pleasure – often it happens and we simply rush to the next thing, and it’s the same with sex.’
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Aram agrees with this mindful approach. ‘I encourage an exploration of touch for pleasure,’ she says. ‘I’ve had women tell me they had an orgasm when their partner started stroking their coccyx at the bottom of their back, or the back of their neck while having sex. In reframing what we’ve been taught about orgasm and embracing the whole body as a potential touch zone, we can rebalance expectations around what we think our body should be doing, and focus on that feeling of pleasure and how to build it.’
Sometimes it’s even a case of looking at breathwork, says Aram. ‘A good tip is to try taking in more oxygen than you need to as you become more aroused,’ she suggests. ‘Trust me, you’ll be surprised where you can go!’
