Sexual and relationship therapy can be helpful for an individual or couple who feel their difficulties are affecting their quality of life. It can be a big step to decide to embark on therapy , here’s an idea of what to expect if you do.
The person you see might call themselves a ‘psychotherapist’, ‘psychologist’ ‘psychosexual therapist’ or a ‘counsellor’, but they will work in similar ways. They will sit with you and help you to talk and think about what is going on.
Therapy sessions usually last for 50 minutes. You might see your therapist every week, but with Sexual and Relationship Therapy appointments can be less often than that (e.g. every two or three weeks) to give you time to try out any exercises. The first session is sometimes a bit longer so that the therapist can take an assessment.
The Assessment Session
The therapist will want to find out about you and what you are going through. In the first session he or she will ask you to explain why you have come to therapy, and talk about the problem you are having.
If it is a sexual problem, they are likely to ask about any medical problems you’ve had or any medication you take. If it is a relationship problem they will probably want to know about the relationships you’ve had in your life, how they started and ended. If you go to therapy with a partner then the therapist will probably ask you both to describe your relationship and any difficulties you are having.
You should use the assessment session to find out anything you want to know about how this therapist practises and what to expect from their service. Some therapeutic approaches are summarised here. An NHS clinic might only be able to offer a limited number of sessions (6, 10 or 20 are common limits). A private therapist will charge and you will probably want to know how much and how you go about cancelling sessions if you can’t attend one week.
The therapists should tell you about the contract they work to and may give you a copy and ask you to sign it. This will outline the boundaries for therapy. They should also tell you about the Code of Ethics they adhere to. You can see COSRT’s Code of Ethics for General and Accredited Members.
The end of the assessment session is a good time to think about whether you and this therapist are likely to work well together. It is up to you to choose your therapist but it’s worth knowing that at some clinics the person who does the assessment may be different to the therapist you see.
After the Assessment
The main point of Sexual and Relationship Therapy is to give you a safe space and regular time to talk about what is going on in your life.
The focus is generally on sexual or relationship issues, but these may be linked with what is going on in the rest of your life – stress, problems at work, financial, family or physical difficulties. It is fine to talk about these issues too.
The main thing to expect is to be talking about what is going on in your life. Therapists are usually skilled at helping you to do this, so don’t be worried about not having anything to say. Some people find it useful to keep a journal or notes between therapy sessions to remind them what they want to talk about.
When you go to therapy with someone you’re in a relationship with, the therapist may encourage you to talk to each other more than to them. This is because relationship therapy aims to help you to communicate well about your relationship. The therapist might ask you to have a conversation about a disagreement you’re having, or they might suggest ways that you could ask each other questions or respond to each other and get you to practice this.
What Can Therapy Achieve?
Some people go to therapy hoping that the therapist will fix all their problems but it is really only you (and your partner if you are going as a couple) who can make changes in your lives. The therapist can help you think about what you want and how you might go about getting it, but they can’t do it for you.
Therapy works best for people who are really committed to it. Try to make time for therapy and also make time between sessions to think about what you have discussed or to try out ideas. It helps if you are open-minded and ready to think about different possibilities.
Some people with sexual issues think that they are entirely physical problems and don’t see the point in talking about their feelings or relationships. It is true that sometimes sexual difficulties are linked to a physical problem such as a heart condition, multiple sclerosis or diabetes. Your doctor should certainly examine that possibility before referring you for therapy. However, even in these cases therapy can help you to adjust to those changes and explore what kinds of sex are possible given your condition and any medication you need.
You will get the most out of therapy if you are ready to talk about things like your views on sex, how you feel about your problem, and how you communicate with you partner, if you have one.
What Won’t Happen
If you go to a Sexual and Relationship Therapist then you won’t be expected to have any kind of medical examination or to take your clothes off unless the therapist is medically trained to undertake medical examination.
If you decide, with the therapist, that there is anything physical that needs checking out then they can refer you back to your GP, or another specialist doctor, who can do that.
You don’t have to answer any questions you feel uncomfortable with or do any exercises that you don’t want to. Sometimes it takes a few sessions to feel comfortable talking with a therapist so it may be that you don’t say everything straight away.
The therapist is very unlikely to tell you what to do. They may suggest things that have worked for other people, or things they believe you might find helpful but mostly they are there to listen to you and help you find your own way.
COSRT has a Code of Ethics which states clearly what counts as ethical and unethical behaviour. If you feel that your therapist has acted unethically then you should end your therapy and consider making a complaint to the clinic, to the person who referred you, or to COSRT or any other organisation that accredits that therapist. Examples of unethical behaviour would include them touching you in a way you found uncomfortable, or writing about their work with you without getting your permission. You can find more information on how to complain to COSRT about one of its members in our Conduct Procedure.
The therapist will normally not tell anyone outside their practice about you and your problems. However there are some circumstances where confidentiality will be broken and you need to be aware of this.
For example: It is a condition of practice that therapists have a supervisors who helps and supports them in their work with their clients. Your therapist will probably talk about their work with you to their supervisor for this reason. Your details are always kept anonymous in these discussions.
Therapists will probably make some notes about their sessions with clients to help them to remember what you have talked about. Such records will also be kept confidential, for example in a locked filing cabinet, or on a computer file which only doctors and therapists working with you have access to. Under the Data Protection Act you also have the right to see any records kept on you.
Confidentiality has to be broken when there is good reason to think that someone might harm themselves or somebody else, but wherever possible this will be discussed with the client first. There are a limited number of circumstances where the law requires confidentiality to be broken, in cases involving terrorist activities, drug trafficking or money laundering for example. Sometimes court cases or complaints can also mean that confidentiality is compromised.
This may sound like a long list, however in the vast majority of cases the details of what is discussed in therapy will be between the therapist and the client. If you want to know exactly how confidentiality works with your therapist then it is a good thing to ask them about it in the assessment session.