What is sex therapy and what happens in a session?

Sex therapy is a specialized form of psychotherapy focused on sexual difficulties — desire discrepancies, arousal problems, pain, compulsive sexual behavior, the aftermath of sexual trauma, and the broader question of what a person actually wants from erotic life. It sits at the intersection of behavioral technique, relational work, and, in its deeper registers, something closer to depth psychology: an inquiry into what sexuality is for in a given soul.

The clinical picture of a session varies considerably by orientation. Behaviorally inflected approaches — sensate focus exercises, psychoeducation about arousal physiology, cognitive restructuring of shame-laden beliefs — tend to dominate the popular image of sex therapy. A couple like the one Esther Perel describes, where one partner experiences the body as "a gathering place of multiple taboos and anxieties" while the other finds in sex "a place where he feels utterly free," might spend sessions learning to translate between two entirely different somatic languages: one partner reaching for words, the other reaching for touch. Perel's framing is useful here — she describes the therapist's task as making each partner "more fluent in the language of the other," which is less a technique than a relational orientation.

Somatic and trauma-informed approaches go further into the body itself. Fogel's neuroscience of interoception is directly relevant: suppression of sexual arousal activates the dorsolateral prefrontal cortex in a way that holds inhibition in working memory, effectively crowding out the insula, orbitofrontal cortex, and anterior cingulate — the network through which pleasure is actually registered. What this means clinically is that a person who has learned to suppress erotic feeling does not simply choose not to feel; the neural architecture of suppression is itself running, consuming attentional resources, and generating downstream effects including avoidance of arousal more broadly. A somatic therapist works with this not by talking about it but by slowing down, tracking body sensation, and creating what Fogel calls "safe opportunities to access [feelings] more freely."

A state of psychological and physical well-being requires us to suppress our feelings when needed but then to find safe opportunities to access them more freely. Problems arise when suppression continues without respite.

Trauma-informed sex therapy — particularly with clients whose sexual histories include abuse — involves careful attention to the action systems Ogden describes: sexuality, attachment, and play are distinct but interpenetrating systems, and trauma frequently uncouples them. A client may be capable of sexual activity while entirely dissociated from attachment or pleasure; another may find that any erotic arousal triggers a defensive collapse. The session becomes a space for studying these patterns as they arise in the body, not merely narrating them.

What depth psychology adds to this picture is a different kind of question entirely. Hillman, reading the myth of Eros and Psyche, insists that the soul is tortured by love — not accidentally, not as a pathology to be corrected, but as something the myth presents as structurally necessary:

The torture of the soul seems unavoidable in every close involvement, of which the transference of an analysis is one example. Despite all one does to avoid and to alleviate suffering, it would seem that the process in which the people find themselves arranges it, as if we were driven by a mythical necessity to enact Psyche and Eros.

This is not a clinical recommendation for suffering — it is a diagnostic observation about what sexuality carries. Eros, in the Jungian reading Jung himself offers in the Dream Analysis seminars, is not reducible to sexuality: "He may be love, he surely is not sex alone." The naked boy in the dream is introduced as a deity, an autonomous principle, and Jung notes that the old Greeks did not say a man fell in love but that "the arrow of Eros has hit him" — the emotion was understood as something that happened to the person, not something they generated. When Eros is undeveloped, Jung observes, what results is "unrelated sex, a sort of auto-eroticism" — technically functional but without genuine object-relation, without the Eros principle that makes sexuality a meeting rather than a discharge.

What happens in a sex therapy session, then, depends entirely on what the therapist understands sexuality to be. At its most behavioral, it is skill-building and anxiety reduction. At its most somatic, it is the slow recovery of interoceptive access. At its most depth-psychological, it is an encounter with what Perel calls the Holy Grail question — what is sex a quest for? — which turns out to be a question about the soul's specific logic of longing, not a question about technique at all.

  • eros — the Jungian understanding of Eros as relational principle, distinct from sexuality
  • anima — the soul-image and its role in erotic projection and transference
  • James Hillman — portrait of the archetypal psychologist whose reading of Eros and Psyche reframes erotic suffering
  • embodiment — the somatic dimension of psychological life and its clinical implications

Sources Cited

  • Fogel, Alan, 2009, Body Sense: The Science and Practice of Embodied Self-Awareness
  • Hillman, James, 1989, A Blue Fire: The Essential James Hillman
  • Jung, C.G., 1984, Dream Analysis: Notes of the Seminar Given in 1928–1930
  • Perel, Esther, 2007, Mating in Captivity
  • Ogden, Pat, 2015, Sensorimotor Psychotherapy