One thing that can make finding a therapist tricky is that therapists often have quite different kinds of approaches or styles. It can be hard for people who don’t know much about psychotherapy to find someone with an approach that suits them.
Here is a brief outline of some of the main forms of therapy. Reading through it might make you think about which makes most sense to you. When you see a therapist you can ask about which approach they use and see if you will be able to get on with them.
Cognitive Behavioural Therapy (CBT)
(sometimes just called Cognitive Therapy)
Therapists using the CBT approach generally think that we get into habits of behaviours or ways of thinking that aren’t helpful. They try to help people to identify these behaviours or thoughts and then change them.
CBT therapists are most likely to use techniques or exercises. For example if you’re getting anxious a lot they might ask you to note down each time you get anxious during a day and record what you were thinking just beforehand.
In Sexual and Relationship Therapy examples of the kinds of things a CBT therapist might do include using relaxation exercises if you’re feeling anxious about sex, or helping you to explore what kind of thoughts you are having and change them for more useful thoughts.
(sometimes called Humanist or Client-Centred Therapy)
This kind of therapy is focused on the client talking and the therapist listening and concentrating on understanding how the client is feeling: seeing things through their eyes.
The idea is that we all know what is best for ourselves but as we get older that knowledge is undermined by our experience in life. Having a space and time to talk about this with a therapist can help you to feel safe enough to find out what is best for you and what you want.
In Sexual and Relationship Therapy this might involve you thinking about all the ideas you have about what makes a good relationship or a good sex life. Which of those do you really agree with, and which of them are unhelpful messages which just make you feel bad about yourself? For example some people might think that they have to have sex a certain number of times a week even if they don’t feel like it, Person-Centred Therapy might help them to focus on what they really enjoy.
(sometimes called Psychoanalytic Therapy)
Like Person-Centred Therapy, Psychodynamic Therapy is largely based on the client talking and the therapist listening and encouraging. Psychodynamic therapists believe that many of the troubles we experience are because we hide things from ourselves. The aim of therapy is to help clients be more open with themselves about these things.
Psychodynamic therapists help clients to explore their feelings and think about what causes them. They may also draw links between how a client is in therapy, how they are in the rest of their life, and how things were for them in childhood.
For example, in Sexual and Relationship Therapy a therapist who has talked with a client for some time might say ‘it seems like you are anxious about having sex but I wonder if what really scares you is being vulnerable in front of another person?’ or they might say ‘I notice that you pause for a long time before you tell me something important, and you also say that you partner complains that you don’t tell him important details about your life. I wonder if that links back to how you say your parents didn’t listen to you as a child. Perhaps it’s hard to trust that people will listen to you now?’
(sometimes called Phenomenological Therapy)
This kind of therapy generally believes that a lot of people’s problems are because we get stuck in certain ways of seeing things. Probably these ways were useful at one point in time, but they are not so useful now. Existential Therapy helps people to challenge themselves and explore their options.
Like Person-Centred Therapy, Existential Therapy believes that people can help themselves. The therapist spends a lot of time listening to the client and trying to see the world through their eyes. Like Cognitive Behavioural Therapy it challenges unhelpful ways of thinking. But Existential Therapy believes that there are always good and sensible reasons for the ways that we are thinking and behaving, just that they might not be so useful to us now.
An existential therapist believes that all humans have difficult times – including the therapist! It is normal to struggle and useful to listen to the difficult feelings and find out what they have to tell us. For example, a couple might be struggling to have sex and realise that one of them is doing it mostly because they’re scared that they will lose the relationship if they don’t, while the other one is doing it mostly because they think that being able to give another person pleasure is the sign that they are successful. Perhaps if they can reassure each other of these things in other ways then they will be able to enjoy sex more easily.
(sometimes called Family Therapy)
Systemic therapy looks at people as part of a relationship, family, or network. Problems are seen as part of the whole ‘system’ . In Sexual and Relationship Therapy, people in couples often see a problem as one person’s ‘fault’. A Systemic Therapist would see it as something that happens between them.
For example, it is not unusual, when one person is struggling to get sexually aroused for both people in a relationship to blame themselves. The person who is unaroused feels that their body isn’t working properly and they should be able to fix it. The other person worries that they might not be attractive enough. The Systemic Therapist would help them to express these worries and see how that anxiety, and not speaking about it, might be making the problem worse.
Alternatively, people might blame each other. One person might complain that the other never tidies up, whilst the other might complain that their partner is always nagging. A Systemic Therapist would help them see the dynamic between the two of them, where the first person feels unappreciated when their partner leaves them to do all the housework, and the other person feels useless when their partner complains. It is no one person’s ‘fault’.
Integrative therapists recognise that clients are individuals, with different and complex relationship and family histories who may also have individual relationship needs in the present.
What works and supports one client or couple, may not work for another. Integrative therapists are skilled at drawing on different schools and models of psychotherapy and ways of working with human behaviour whilst respecting client autonomy, in order to facilitate the most effective therapy for each individual client in an integrated style. They also tend to work in a more holistic framework attending to the body mind and spirit, as well as the environment in which the person lives in.
Approaches Other Than Talking Therapy
Finally it is important to say that ‘talking therapy’ is not the only way of addressing Sexual and Relationship issues.
There are all kinds of other therapies that you might find useful which aren’t based around talking: for example art therapy, drama therapy and nature therapy. There are also therapy groups where people with similar issues help each other to deal with them. Some clinics and community centres may offer these.
There are many self-help books about Sexual and Relationship issues which you can read. Many of these contain similar exercises to those used by Sexual and Relationship therapists. You can try these yourself, although many people find attending therapy for a few sessions helps them with the motivation to do this.
Some people find writing about their issues useful and keep journals. Others prefer silent contemplation, meditation or prayer of some kind. Many find talking with friends useful, if they have someone they feel comfortable opening up to about these issues.