Psychotherapy isn’t advice, cheerleading, or a quick fix. It’s a sustained conversation — about your life, your patterns, your past, and what it feels like to be you.
People usually come because something’s not working. It might be a crisis, a sense of stuckness, or just a creeping feeling that you’re going through the motions. Sometimes, the problem is clear. Sometimes, it’s more like a knot that won’t untangle — anxiety, relationship difficulties, self-criticism, shame, or a nagging sense that you should be “more sorted” by now.
My approach is psychoanalytic, which means we pay attention to what’s going on beneath the surface — unconscious beliefs, early experiences, and relational dynamics that shape how you see yourself and others. We’ll work together to notice the patterns that repeat, the roles you feel cast in, and the feelings that are hard to name or bear. Often, what seems irrational or self-sabotaging begins to make sense in the light of your history.
I offer a space that’s thoughtful, honest, and alive. Not just a place to vent, but somewhere you can bring the unfiltered version of yourself — including ambivalence, resistance, and contradiction. The work is about making room for all of it, not rushing to tidy it up. As trust builds, you’ll likely find that new insights emerge, not through being told what to do, but through feeling heard, recognised, and understood in a way that shifts something fundamental.
You don’t need to have the right words. You don’t need to know where to start. Just bring what’s real — dreams, memories, conflicts, irritations, longings. We’ll begin from there.
What about sex therapy?
Sex can be many things: a source of joy, connection, release, identity, power, anxiety — or absence. It’s shaped by biology, emotion, culture, memory, fantasy, and relationship. And yet, despite being everywhere in public — the media, the apps, the jokes — it can remain unspeakably private. For many, talking about sex in therapy feels like stepping into exposed territory: vulnerable, shameful, or simply unfamiliar.
My approach to sex therapy makes space for all of this. Whether you’re struggling with desire, function, shame, compulsivity, confidence, performance, pleasure, or pain — we’ll work at the pace you need. We’ll look at what’s going on in your body, but also what’s going on in your mind. Often, it’s the unspoken stories — about what sex is supposed to mean, who it’s for, how it should happen — that tie us in knots. Those stories can come from family, religion, porn, past trauma, medical diagnoses, social expectations — or a quiet sense that you’re not normal.
Some people come because sex feels disconnected or mechanical. Others come because it feels overwhelming, dangerous, or out of reach. Common experiences include low libido, difficulties with arousal or orgasm, pain during sex, unwanted fantasies, erectile issues, or the feeling that sex has become performative or compulsive. But the symptom is often just the tip of the iceberg.
Good sex — the kind that leaves us feeling satisfied, not just spent — asks a lot of us. It asks us to be present, attuned, receptive. That’s hard to do when we’re stuck in anxiety, guilt, self-surveillance, or trauma. It’s also hard when life is full of noise: health worries, relational tension, money stress, fear of rejection, internalised stigma. In therapy, we turn down that noise and start listening differently — to your body, your mind, and your wants.
You don’t need to know what the problem is. You don’t need to show up with a partner, a diagnosis, or a plan. You just need to be willing to be curious. Together we’ll explore your sexual story — what’s shaped it, what’s sustaining it, and what might want to shift.
Sex therapy is not about fixing you. It’s about understanding you. And from that understanding, change becomes possible.
What makes you a sex therapist?
For five years, I worked as a Principal Clinical Psychologist in HIV and sexual health at Barts and the London NHS Trust. My work focused on men’s sexual health, including erection and orgasm difficulties, sexual risk-taking, and the psychological impact of living with HIV and other STIs. I worked extensively with men who have sex with men — many navigating stigma, shame, trauma, or compulsivity — as well as with individuals and couples adjusting to life after an HIV diagnosis.
That work taught me that sexual problems are rarely just about sex. They often reveal something deeper: unmet needs, unprocessed histories, unspoken conflicts. Therapy creates a space to explore what’s going on beneath the surface — and to do so without judgement, diagnosis, or performance pressure.
People come to sex and relationship therapy for all kinds of reasons, including:
- Difficulties with arousal, orgasm, or pain during sex
- Concerns around sexual safety, impulsivity, or risk
- Processing traumatic or unwanted sexual experiences
- Struggles with emotional or physical intimacy
- Questions around sexuality, identity, or gender — their own or a partner’s
- Exploring kink, fetishes, or other preferences in a non-pathologising space
- Negotiating trust, boundaries, or commitment in relationships
- Patterns in forming, maintaining, or ending relationships
- Living with or disclosing HIV or other STIs
Whether you’re dealing with something new or something long-standing, therapy can offer a space to make sense of it — and to begin a different conversation with yourself, your body, and the people you connect with.
I’d prefer to see a female therapist
Do feel free to come and meet me to see if we can work together. It can be surprisingly refreshing and useful to think and talk about sex with a man, even and especially if it feels too scary! If you really would rather see a woman, I can recommend Dr Libby Nugent, who has worked alongside me since 2008.
Dr Russel Ayling 