Combination Couples Therapy/Sex Therapy

Sex problems and relationship problems often go hand in hand, so it’s only natural that most couples want to deal with both simultaneously. Unfortunately, many psychotherapists are not adequately trained in sex therapy, and thus often prefer to work on the relationship issues first with the idea that fixing a relationship will naturally fix the sex problems as well. This assumption is flawed. While improving a relationship in areas such as communication can indeed have a positive effect on a couple’s sex life, these benefits are generally minimal and indirect, and do not make sex problems go away. And when sex is regarded as a secondary concern to be dealt with later, untreated sex issues will often worsen, with disastrous effects for the overall relationship.

Conversely, sex can be a source of tremendous resilience and positivity for couples who are grappling with other relationship challenges and be a "glue" that help couples survive difficult periods. Studies have shown that couples who maintain their sexual connection once a week are more satisfied overall in their relationships than couples who do not1, and that sex produces a positive "after-glow" that lasts for up to two days, and this afterglow is linked with relationship quality over the long term2. For these reasons, sexual issues cannot be placed on the back-burner. As a licensed marriage and family therapist and certified sexuality counselor with deep clinical experience, Ian has developed a form of combination therapy that seamlessly integrates couples and sex therapy into a single process, allowing couples to work in parallel on sex and relationship issues from the very first session.

In addition to assessing and treating the causes of sexual issues that may be challenging to one or both partners, during combination therapy we also pay close attention to the impact of sexual issues on the relationship and the discrepancies that have emerged. Common sexual discrepancies include:

  • Frequency of sex — a discrepancy in partners’ levels of desire is very common
  • Type of sex – a discrepancy in partners’ sexual preferences and sexual temperaments
  • Expectations of intercourse (e.g., length, style, positions, eye-contact)
  • Variety of sexual practices (e.g., preference for types of pleasuring, oral sex, anal sex, sex videos, BDSM activities, sexy apparel, erotic scenarios)
  • Sexual interaction (e.g., who initiates, arousal styles, orgasm patterns)
  • Acceptability of masturbation with/without partner and use of pornography
  • Acceptability of sexual fantasy
  • Acceptability of sex toys (e.g., dildos, paddles, vibrators)
  • Acceptability of substances to facilitate sexuality (e.g., alcohol or marijuana)

Once a discrepancy has been explored and reflected upon, it’s often possible to take a “Bridge-Bend-Bond” approach in which:

  • new sex scripts are negotiated
  • flexibility, vulnerability and resilience are demonstrated and acknowledged by both partners
  • and the relationship-benefits of overcoming a sexual impasse together are reaped3

1. Muise, Amy, Ulrich Schimmack, and Emily A. Impett. "Sexual frequency predicts greater well-being, but more is not always better." Social Psychological and Personality Science 7.4 (2016): 295-302.

2. Andrea L. Meltzer, Anastasia Makhanova, Lindsey L. Hicks, Juliana E. French, James K. McNulty, Thomas N. Bradbury. Quantifying the Sexual Afterglow. Psychological Science, 2017.

3. McCarthy, B., Metz, M. E., & Epstein, N. (2017). Cognitive-behavioral therapy for sexual dysfunction. Routledge.