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About Sexual and Relationship Therapy
We all feel anxious when we’re having problems in our relationships or with our sex life. Many people find it too painful to talk to anyone else about their fears, even their partner. Sexual and relationship therapy can be helpful for an individual or couple who feel their difficulties are affecting their quality of life in an emotional, psychological or physical way. It’s a big step to decide to embark on therapy but here’s an idea of what you can expect if you do take this step.
There are three places that you are likely to go for sexual and relationship therapy. One is to a sexual and relationship therapy clinic, which might be part of a hospital. The second is to an agency where a number of therapists work such as Relate. The third is to a private therapist who specialises in sexual and relationship therapy. A private therapist might work out of an office or their own home.
The person you see might call themselves a 'psychotherapist' or a 'counsellor'. Their training will be different but they will work in similar ways: they will sit with you and help you to talk and think about what is going on. For more information look at some therapeutic approaches.
People often get confused between 'psychiatrists', 'psychologists' and 'psychotherapists'. Psychiatrists are medical doctors who specialise in emotional or psychological problems Only psychiatrists can write prescriptions for drug treatments. Psychologists have a degree in psychology and some of them then train in 'counselling' or 'clinical' psychology after this and work in similar ways to a psychotherapist or counsellor. Some nurses are also trained in Sexual and Relationship Therapy and work in similar ways. Many of these professionals will have completed specialist courses to enable them to assess and treat sexual and relationship difficulties in a supportive and non-judgemental atmosphere.
Before embarking on therapy, please look at the section on this website called finding a therapist. This will help you to make an informed choice about your therapy. If you see a private therapist then you will probably call them yourself to make an appointment. To find a private therapist look at our lists of therapists. If you go to a clinic you will probably be referred by your GP. You may be sent some forms or questionnaires to fill out before attending to give the therapist an idea of what you want to talk about.
Therapy sessions usually last for 50 minutes. You might see your therapist every week, but with Sexual and Relationship Therapy, appointments can be more spread out than that (e.g. every two or three weeks) to give you time to try out any exercises. Also, the first session is sometimes a bit longer so that the therapist can take an assessment.
The Assessment Session
The therapist is likely to focus on finding out all about you and what you are going through. In the first session they will ask you to tell them about what brings you to therapy, why you have come now, and a bit about the history of the issues.
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, and that kind of thing. 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 also use the assessment session to find out anything you want to know about how this therapist practises and what to expect from the 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. They should also tell you about the Code of Ethics they adhere to. You can see COSRT's Code of Ethics here.
Towards the end of the assessment session the therapist is likely to ask you what your hopes are from therapy and you will discuss what you might be able to achieve. Some people find it useful to think of it as a scale of 1-10 where 1 is the worst that the issue could possibly be and 10 is how it would be in an ideal world. Think about where you would put yourself on this scale now. It is unlikely that you will get all the way up to 10 in therapy, but what number do you think you could realistically get to? What would it take to move you just one point up the scale?
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 its worth noting that at some clinics the person who does the assessment may be different to the therapist that you are assigned to.
So for the first session it is worth coming with:
- Any forms you have been asked to fill in
- Answers to the question of what brings you to therapy, why you have come now and what the background is
- Any relevant medical information such as the names of any drugs you are prescribed
- Any questions you have about how the therapist or clinic works
- Your diary so that you can arrange the next appointment
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 well be linked with what is going on in the rest of your life such as stress, problems at work, financial, family or physical difficulties. It is fine to talk about these issues too.
The main thing to expect from therapy 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.
Therapists are all different so you may find that some encourage you to talk openly about whatever is on your mind, whilst others have more specific suggestions about what to talk about or do between sessions. Some may suggest exercises you can do between sessions. For more information go to the section called psychotherapeutic approaches.
When you go to therapy with someone you're in a relationship with, the therapist may well encourage you to talk to each other more than to them. This is because relationship therapy generally 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 these.
What Can Therapy Achieve
Some people go to therapy hoping that the therapist will fix all their problems but in reality it is only you (and your partner if you are going as a couple) who can make changes or address what is going on in your lives. The therapist is someone who can help you to think about what you want and how you might go about getting that, but they can't do it for you.
Sexual and relationship therapists have extensive knowledge and experience of techniques that work well for people who are having sexual or relationship difficulties. They will have some useful suggestions that have been helpful for other people. But it is up to you to decide whether these are things you are comfortable trying and, if not, to talk about this with the therapist.
Therapy works best for people who are really committed. 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. Sometimes there might be options you haven't considered.
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, and 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 to explore what kinds of sex are possible given what has happened and any medication you are on.
In many cases sexual problems come about because of the way your body responds to other things like your feelings, your relationships, and your environment. For example, most people with sexual difficulties begin to get anxious that they will have problems when they next have sex, and this generally makes the situation worse. 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 issues, 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.
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 do. 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.
The therapist should not be unethical in any way with you. 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. COSRT has a Code of Ethics which states clearly what counts as ethical and unethical behaviour. If you feel that your therapist has been unethical 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. You can find more information on how to complain to COSRT about one of its members here.
Confidentiality
One of the most strongly held principles of all therapy is that it should be confidential – just between you and your therapist and most of the time this will hold good. However there are some circumstances where confidentiality will be broken and you need to be aware of this.
The therapist will normally not tell anyone outside their practice about you and your problems. However therapists should always have supervisors who help make sure they are doing good work with their clients. So your therapist will probably talk about their work with you to their supervisor for this reason. They might also ask other members of their team for any advice. Generally speaking they will not tell those people your name or details that might let them know who you are.
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 a person might harm themselves or somebody else, but wherever possible this will be discussed with the client first. There are also a limited number of circumstances where the law requires confidentiality to be broken, for example terrorist activities, drug trafficking or money laundering. 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.