Is a Sex Therapist Required?

By Robyn Salisbury

“Isn’t therapy for Americans Robyn?” This was one of two questions asked recently that highlighted for me the gap between my view of my work and the understanding of uninitiated others.

The second was “Why should people go to see a sex therapist when that’s hard work? It’s much easier to just get a pill.”

It’s an interesting challenge to work in a field that contains so many contradictions. Sex attracts lots of attention but at the same time is still seen by many, perhaps reactively, as a ‘no-go’ area, especially for serious conversation. So many people are actually very poorly informed yet the topic of sexuality is of core relevance to all human beings. It can cause enormous problems when things go wrong or sex is abused and such great pleasure when all is well.

Few of us are taught much at all about our sexuality or about sex beyond the basics of reproduction, contraception and disease. Myths abound, leaving many fearing inadequacy. Nothing more effectively undermines arousal and sexual pleasure than a sense of pressure to perform and measure up.

One of a sex therapist’s roles is to give down to earth, factual information about realistic expectations of sex and relationship. Who better to do that than Kiwis steeped in a no. 8 fencing wire culture blended with professional training that allows us to sift through all the international research and opinion to come up with a non-flaky, straight up and down, effective approach.

Yes, Americans have sex therapists. Europeans have sexologists and Brits have psychosexual therapists. How those services are offered and how they’re used will alter slightly just as the title does according to the culture of the therapist and the client. Basically we all have the same aim: to help people learn to embrace and express their sexuality in healthy, life enhancing ways.

One big difference between Americans and Kiwis that I’ve become aware of is that the latter are much less willing to talk about their sex therapy experiences. I recently finished working with a couple who had made some massive changes. We discussed their delight in their achievements and the difficult process of learning about something that one of them at least hadn’t known existed. They would certainly agree with the second questioner: yes, it had been hard work. Could a pill have achieved it? Well erectile dysfunction was taking place but the presenting problem was the woman’s total withdrawal from sex. Presenting her with an erection when she was saying very clearly that she was not interested in sex was not going to perform any miracles. There was work to do to resurrect the dance of intimacy in this relationship and neither erection pill nor testosterone gel could possibly replace that work. And that’s another Kiwi phenomenon: we know that you just get on with the hard slog, you don’t take shortcuts, effort in = rewards out.

Now that New Zealand allows pharmaceutical companies to advertise their products we hear a lot of promises about drug treatments. The huge number of prescriptions written for erectile dysfunction drugs certainly says something about the number of men concerned about the ability of their penis to become erect.

The small number of repeat prescriptions tells us clearly that these drugs aren’t helpful or tolerable for a considerable percentage of those with a problem. The media interest in testosterone treatments and the billions of pharmaceutical company dollars going into developing new categories of female sexual dysfunction and drugs to treat them suggests clearly there is seen to be a highly profitable commercial market here.

Meanwhile, sex therapists are closely reading all the international literature, noticing the inconsistent research results, the limitations and the warnings coming through. We know that post-prostrate cancer erectile dysfunction (ED) is going to require a different treatment response than ED in a healthy male or one suffering other medical conditions.

We know, as shown in British research published this year, that “loss of libido in otherwise healthy women may be related to relationship problem, depression, psychosexual factors, and sexual dysfunction in the partner but do not appear to be related to androgen (ie testosterone) status.”

We also know that relationships are complex beasts that most of us go into naively with great hopes and good intentions. This is the specialist area of sex therapists: understanding sexuality and its interaction with life events, aging and medical conditions. Then we interweave this knowledge with our expertise about intimate relationships and our understanding of how to help bring about change.

Kiwis are now benefiting from this expertise but those who haven’t may still subscribe to the myth that therapy is for Americans because those who have, often choose not to talk about it. When I asked my departing clients if they’d be telling their friends about their changes, they laughed. “No” was the very brief response.

It was perhaps a big step for Graeme Lowe to tell the country about his ED and how taking a pill fixed it. But it would be a much bigger step again to be acknowledging all the things about intimacy you hadn’t previously known, to be talking about the struggle to learn them and how at times you felt vulnerable in the process.

To reveal your delight in achieving intimate loving. Most of the couples we see aren’t ready to talk openly about such things just yet. So in the meantime, the only way you’re going to get to know about whether sex therapy is for New Zealanders or not, is to try it.

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Robyn Salisbury is a Clinical Psychologist and Director of Sex Therapy New Zealand, a referral network. To seek professional help with any sexual relationship problem Ph 0800 739 843, (0800sextherapy), For more information visit www.sextherapy.co.nz

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