Often referred to as ‘talking therapy’, psychotherapy centres on discussions between therapist and client. These conversations will explore the way you see yourself and others. Thoughts and feelings can be hard to identify alone, and with the help of a therapist you can discover what these are and begin to free yourself. Most people experience difficulties at some stage of their life and need to come to terms with pain or disappointment. Often the individual can resolve this without outside help. Sometimes, however, the difficulties persist, causing unhappiness at home and at work. This may be because current difficulties are stirring up feelings from the past of which the person is not consciously aware.
Psychotherapy can enable individuals to understand hidden aspects of themselves. It is commonly thought that talking about what troubles or scares you will only stir things up. In reality, putting things into words and naming difficult emotions has a quietening effect. The construction of your story that takes place with a psychotherapist enables to you take perspective – literally a mental distance – from your emotions and problems. Psychotherapy involves talking about things, and things can be changed by something as simple as words. Psychotherapy is a safe space for you to review your life, reflect and explore how you relate to others in your personal and professional life. It is a place to be honest with yourself in order to have a more satisfying life.
You can bring to the session whatever is on your mind – feelings, thoughts, memories, dreams. As your relationship with the therapist develops, you will discover new insights and find different ways of coping with problems and feelings. Psychotherapy consists of face-to-face meetings between the therapist and an individual, a couple or a family. The first few sessions will be an assessment period: the focus will be on looking at the presenting issue and situation in the context of your relationships with others.
Treatment will involve an exploration of alternative ways to deal with the problems identified and provide a renewed focus for pursuing your life goals. It is not a quick fix, but takes effort and can be challenging in many ways.
What about sex therapy?
Sex and relationships are everywhere in the media, but the idea that people are sexual can still be looked at with embarrassment or disgust, particularly if sex is linked to health difficulties and fears of transmission of illness. Sex can be seen as a spiritual act, a physical need or drive (like sleeping) and it’s how we have children. These reasons (and more) will be seen as having varying ‘truth’ or importance to different people. Regardless of beliefs about why people want or need sex we know that sex can do our minds and bodies good in a number of ways. Sex can relieve stress, provide physical and emotional closeness, it’s an opportunity for fun, it boosts our immune system, it can be a good workout, it helps us to feel powerful, can influence our self-esteem and confidence and can help us sleep.
In society, we have a lot of social rules and pressures about sex. These rules tell us what is ‘normal’ or ‘OK’ and what is not. The rules each individual follows will be informed by community and culture as well as unspoken rules learned from each family. Getting it right (performance, style, with who, where, at what age, how often) can therefore be a source of anxiety as we inevitably associate sex with personal worth and social judgement.
Our ability to have and enjoy sex can be impacted on for many different reasons. Not only do we need the mechanics of our bodies to be functioning, we also need to be able to have effective mind-body links. This is because, typically, to have sex we need to ‘turn the volume down’ from some of the bits of our brain that encourage us to follow social rules – this bit of our brain is also influenced by worry and fear. At the same time we allow other bits of our brain to have the ‘volume turned up’ for sensory information such as sight, sound, smell and touch. If we have a lot of worries, whether it is paying the bills, work stress, past experiences of abuse or trauma, problems with our family or living with a health condition or sexually transmitted infection, these worries can be so loud that they are difficult to ignore. As such our interest and enjoyment in sex becomes more difficult. The physical consequences of this can include: lack of sex drive, difficulty in becoming wet or getting hard, problems relaxing enough to allow penetration, experiences of pain during sex, and difficulties with orgasm or ejaculation.
Some people may desire less sex; others may experience an increased sense of need for sex, but perhaps with less sense of emotional satisfaction. If you’re struggling with these issues, now might be a good time to come for sex therapy. Meeting a therapist might already feel difficult enough, but doing so to talk about sex might feel particularly overwhelming. It’s important to remember that sex therapists are used to having these conversations! Typical fears or worries include: ‘It’s broken’, ‘ I can’t cope’, ‘I’m never going to have sex again’, ‘I’m out of control’, ‘I’m disgusting’, ‘My partner/family will leave me’, ‘I will never be able to find a partner’, ‘I can’t tell anyone as I will be rejected’, ‘I’ve given it to someone’, ‘I should have kept myself safer’, ‘I’m stupid’, ‘What’s the point?’. With such frightening stories it becomes important for individuals to recognise what they are thinking and feeling and how these stories might be feeding their fears. It is also important to think about why these thoughts might not be entirely ‘true’. Sex therapists can help you do both of these things, and then help you consider different ways of thinking, feeling and doing!
What makes you a sex therapist?
I spent five years working as a principal clinical psychologist in HIV and sexual health at Barts and the London NHS Trust. There, I specialised in men’s sexual health, working with a range of sexual difficulties (including problems with erection and orgasm) and with men who have sex with men who are at high risk of contracting or transmitting HIV and other STIs. I also worked with men and women who were adjusting to and living with HIV. Clients coming for sex and relationship therapy typically want to talk about one or more of the following issues:
- Arousal, orgasm and pain in sex
- Sexual safety and risk-taking
- Coming to terms with a traumatic sexual event
- Negotiating emotional and physical intimacy
- Understanding theirs or their partner’s sexuality and gender
- Exploring kink, fetishes and other sexual preferences
- Discussing commitment, trust, and differences in relationships
- Difficulties in forming, maintaining and ending relationships
- Talking about and living with HIV and other STIs
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 