Therapy Practicalities

Therapy sessions usually last for 50 minutes. You might see your therapist every week, but with Psychosexual 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 given. The first session is sometimes a bit longer so that the therapist can take an assessment.

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 issues 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 practices and what to expect from their service. 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 must tell you about the contract they work to and give you a copy and ask you to sign it. This will outline the boundaries for therapy. They should also tell you about the COSRT Code of Ethics and Practice that they adhere to.

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.

A key point of Psychosexual and Relationship Therapies is to give you a safe space and regular time to talk about issues affecting you. 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 too.

Therapists are skilled at helping you open up, 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.

Some people go to therapy hoping that the therapy 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 Psychosexual or 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, and there is a need for the examination. In those instances the person would not be working as a therapist at that point but would instead be carrying out their work as a medical professional.

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 and Practice 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 on our website.

The therapist will normally not tell anyone outside their practice about you and your problems. However, there are some circumstances where confidentiality might be broken and you need to be aware of this.

Confidentiality can 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.

In most cases the details of what is discussed in therapy will be between the therapist and you.